We report on a 19-year-old man with a 6-month history of pain and stiffness in the upper cervical region who proved to have a lytic lesion affecting the anterior and posterior elements of C2-4, causing a severe gibbous deformity at C3. The tumour was excised through a posterior approach, and spinal fusion with instrumentation was performed. Two weeks later, through a right-sided, anteromedial approach, the remaining tumour was excised, and the spine was reconstructed with tricortical iliac bone as a strut graft. The patient was placed in a Minerva jacket for 3 months, during which time a solid fusion was obtained. The histological diagnosis was aneurysmal bone cyst. The patient has remained pain free and suffered no recurrence 2 and a half years after surgery. Involvement of several adjacent cervical vertebrae by an aneurysmal bone cyst is rare, and conventional treatment with curettage and bone grafting is most likely to carry a high rate of recurrence and spinal instability. We recommend complete excision of the tumour in a combined staged procedure and instrumentation to prevent recurrence and avoid instability.