Background and Importance: For the cervical spine, managing the pathological body of the axis tumor is controversial. In older patients, major procedures may be hazardous, and non-operative treatment is associated with cervical instability.

Case Presentation: A 70-year-old woman presented with chronic neck pain, mild quadriparesis, and a “sensation” of skull instability. Computed tomography (CT) showed a lytic lesion involving almost the entire body of the C2 vertebra. Magnetic resonance imaging (MRI) revealed a hypotensive infiltrative lesion involving the axis. Posterior cervical fusion was suggested to improve clinical symptoms and prevent future vertebral collapse with catastrophic neurological consequences. Under general anesthesia and neurophysiological monitoring, one-stage surgery was performed with C1 laminar hook and C3-C4 lateral mass screw insertion. A cytological sample from the lytic lesion was transpedicular through C2. Her neurological function recovered well, and he could walk independently 15 days postoperatively. Histopathology with further immunohistochemistry (IHC) of the C2 vertebral body also showed plasmacytoma.

Conclusion: No specific approach is observed to treat the axis’s rare, solitary pathological lesions. Posterior cervical fixation has proven safe and effective in palliative treatment, improving neurological function and cervical stability at the beginning of early chemotherapy.