Primary osteosarcoma of  cervical spine is a rare condition with poor prognosis .The clinical, radiological as well as histopathological features of osteosarcoma vary widely, often leading to diagnostic difficulties. The report highlights the rarity of osteosarcoma of the cervical vertebra wherein the radiological and clinical findings suggested an infective pathology and histological findings remained the gold standard for final diagnosis of neoplastic etiology. A 21-year-old female presented with pain in the nape of the neck and tingling numbness in left upper & lower limb. On examination patient had quadriparesis. Radiological investigations were suggestive of infective etiology most likely Koch’s causing involvement of C3-C5 vertebrae with prevertebral, paravertebral, parapharyngeal and intraspinal infective soft tissues abscess. She underwent C4 laminectomy with excision of the lesion and C1-C7 fixation with titanium Hartshil. The patient eventually died in the post-operative period. The intraoperative squash diagnosis was reported as a spindle cell tumor with malignant potential. The subsequent neuropathological diagnosis of C4 vertebral tumor on paraffin sections revealed characteristic features of osteogenic sarcoma (osteoblastic variant) showing osteoblastic giant cells and neoplastic growth of atypical spindle shaped cells arranged in sheets and trabeculae laying down mineralized osteoid and permeating the adjoining host bone. Early detection and accurate diagnosis is important for improving not only patient prognosis but also the quality of life. We should always consider this rare entity, particularly in young patients who present with intractable neck pain.

Keywords: Primary osteogenicsarcoma, cervicalvertebra, young female, death.