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Biomechanical considerations for stabilization of the craniovertebral junction.

The goal of surgery for stabilization of the craniovertebral junction (CVJ) is to restore biomechanical stability with minimal compromise of physiological range of motion. The CVJ, comprising the basiocciput, atlas, and axis, is highly mobile, contributing to more than half of spinal axial rotation and making major contributions to flexion-extension, particularly at C1-2 and C0-1, respectively. This article discusses the normal biomechanics of the CVJ, the effect of pathology on these normal relationships, and the role of instrumentation in restoring stability.