Instability of the high cervical spine, particularly C1 and C2, is commonly treated via a posterior approach. Access to this region via transoral approaches is often avoided due to the high risk of wound contamination, limited exposure, and lack of experience on the part of the surgeon. We present a 48-year-old man exhibiting complete C2 vertebral body involvement by multiple myeloma with a pathologic fracture, which we treated via the anterolateral/retropharyngeal approach to the high cervical spine. The anterolateral/retropharyngeal approach provides relatively easy access to the anterior arch of C1 and to the vertebral bodies of C2-4 and can be applied to a variety of different conditions. In addition, this approach may be a viable alternative to the transoral route and its associated morbidities.