Introduction <p>Cranio vertebral junction (CVJ) anomalies, whether congenital/acquired (traumatic) are a challenge to manage. A single stage approach can be utilized in the management of all the components of CVJ anomaly in certain cases. The author while managing CVJ anomalies through this approach found it to be very versatile especially in contingency situations. This advantage has not yet been described. The author thus shares his experience of 24 cases and how with proper planning and study of each case and also by keeping available the implants for alternate fixations the contingency situations were handled.</p> Aim <p>To analyze the versatility of Posterior surgical approach of CVJ anomalies.</p> Methodology <p>All CVJ anomalies operated by the author were analyzed using the clinical details, radiological findings, operative notes and post-op clinical and radiological status.</p> Results <p>The author found the posterior approach for CVJ anomalies versatile, it not only addresses multiple components of CVJ anamolies in one stage, for example atlanto-axial dislocations, basilar invaginations, etc., but also in cases of inability to place a particular implant for example a C2 pars screw, a C2 laminar screw/a laminar hook can be placed, there by continuing with the surgery.</p> Conclusion <p>Posterior approach to CVJ anomalies, in select cases, is an easier approach than anterior approach. It also gives alternate options if one type of implant placement is unsuccessful, for example if a pedicle screw cannot be placed in C2 vertebra for any reason, one can place a pars screw or laminar screw or a laminar hook.</p>