'Congenital anomalies of craniovertebral junction presenting after 50 years of age': An oxymoron or An unusual variation?

Congenital CVJ anomalies may present in later half of life, though attempts at reasoning remain speculative. These patients improve after multiplanar realignment and C1-2 fusion. Careful clinico-radiological evaluation is required in those with additional subaxial compression. Bone quality in elderly is not a deterrent for instrumentation. Fusion eventually occurs in most.