SummaryHistorically, injuries to the cervicothoracic junction have presented several challenges to the spine surgeon. Identification of injuries can be difficult given the limitations of plain radiographs in this region, contributing to delays in diagnosis. Attempts at closed reduction of fracture–dislocations are frequently unsuccessful. Nonoperative management of unstable cervicothoracic injuries is commonly afflicted with secondary loss of reduction. Anterior surgical exposures of the cervicothoracic junction are cumbersome and can be associated with notable morbidity resulting from anatomic constraints. Although simpler in approach, posterior instrumentation is limited by available bony fixation points and potential hardware prominence. The authors review the issues regarding cervicothoracic junction injuries and their management.