A 55-year-old woman presented with chronic neck pain. Physical and neurological examination results were normal. Radiographs revealed absence of the posterior elements of C2 with hypertrophy of the spinous process of C3. A computed tomography scan showed occipitalization of the atlas with basilar invagination. Magnetic resonance imaging did not reveal any soft-tissue abnormalities. The patient was treated with a short course of a nonsteroidal anti-inflammatory drug and physiotherapy.Conclusion:
Agenesis of the posterior elements of C2 should be considered in patients with hypertrophy of the spinous process of C3. Patients may have a varied presentation ranging from neck pain to myelopathy. Dynamic (flexion and extension) lateral cervical spine radiographs should be obtained, as cases reported in the literature involved instability of the cervical spine.