Introduction: About 10% of spinal metastases are found in the cervical level. Magnetic resonance imaging is the gold standard for early detection of spinal metastases. The decision whether cervical spine magnetic resonance imaging is requested or not must be made clinically, taking into consideration the patients' detailed pain history.
Case presentation: The case of an 85-year-old patient with a long history of neck pain caused by known multi-level cervical spine degeneration is presented. As conservative treatment became ineffective, he was sent for surgery. Pain character had changed from mechanical to nonmechanical. Therefore, new cervical Magnetic resonance imaging was requested, showing unexpected odontoid process osteolysis. Unknown lung cancer with adrenal and pancreatic metastases was revealed by further investigations.
Conclusion: Detailed pain characterization can already indicate the correct diagnosis. In case of new onset cervical neck pain, magnetic resonance imaging should be performed soon, if pain is characterized as nonmechanical.