Chondromyxoid fibroma of C1: first case report

background: chondromyxoid fibroma (cmf) is a rare, benign primary bone tumor. the cervical spine is an uncommon site for this tumor, with only 10 reported cases to date and none involving the first cervical vertebra (c1). case report: female patient, 25-year-old monozygotic female twin, presented with cervical pain. radiographic imaging demonstrated a contrast-enhanced, right-sided lytic lesion of the insufflated type in c1, with a punched-out appearance and extending to the anterior arch. a postero-lateral and a posterior approach were performed in two steps to resect the tumor followed by occipitocervical fixation. pathology confirmed the diagnosis of cmf. at one year, the patient remains disease free with excellent spinal stability. conclusion: spinal surgeons may need to treat rare spinal tumors. despite the proximity to neural and vascular structures, the goal of surgery is always a radical resection due to high recurrence rates.