BACKGROUND AND IMPORTANCE: This article is the first description of an anterior approach for a biopsy and vertebroplasty of the C2 body and dens. CLINICAL PRESENTATION: A 52-year-old woman presented with a 9-month history of neck pain and a destructive lesion of the dens. The patient was treated with pain medication as well as steroid injections without relief of her pain. A biopsy and vertebroplasty of the C2 body and dens was performed using an anterior cervical approach. CONCLUSION: This report describes the first vertebroplasty of C2 using an open anterior cervical approach.