<jats:sec id="st1">
<jats:title>Background: </jats:title>
<jats:p>Solitay bone plasmocytoma (SBP) account for just 5–10% of all plasma cell neoplasms. They are infrequent in the cervical spine, especially involving the C0–C2 segment. In this article we conducted a literature review and present the diagnosis, management and long term course of two patients with SBP of C2 causing cervical instability.</jats:p>
</jats:sec>
<jats:sec id="st2">
<jats:title>Methods: </jats:title>
<jats:p>We assessed the clinical records of two patients with SBP in C2 and cervical instability attributed to SP-B involving C2. Both patients presented with progressive, severe cervicalgia, and the “sensation” of skull instability. Magnetic resonance imaging revealed an extensive, infiltrative lesion involving C2 vertebral body and lateral masses, consistent with a plasmacytoma.</jats:p>
</jats:sec>
<jats:sec id="st3">
<jats:title>Results: </jats:title>
<jats:p>Both patients underwent emergency posterior surgical stabilization with craniocervical fixation; this was accompanied by a C2 transpedicular biopsy. Postoperatively, patients exhibited no focal neurological deficits and rapidly became pain free. They additional recieved 25 sessions of local conventional radiation therapy. Both patients are doing well as respective 2 and 7-year follow-up.</jats:p>
</jats:sec>
<jats:sec id="st4">
<jats:title>Conclusion: </jats:title>
<jats:p>Although rare, unstable SBP may present atypical cervical location that readily responds to surgical descompression/fusion and radiotherapy.</jats:p>
</jats:sec>
