BACKGROUND There are limited information and inconclusive results for the management of patients with cervical spine metastases. Therefore, we performed this study to evaluate the survival and outcome of these patients, and the surgical risk and complications. METHODS We retrospectively studied 24 patients [14 men and 10 women; mean age, 71 years (range 54-89 years)], with cervical spine metastases, who underwent palliative surgical treatment, from December 2010 to December 2016. Mean follow-up was 14 months (range 1-42 months). We evaluated the survival and the outcome of the patients with respect to pain relief and neurological status, and the surgical risk and complications. RESULTS At the last follow-up, three patients were alive with disease, and 21 patients were dead with disease. Overall median survival was 14.8 months (range 1-47 months). A posterior approach was performed in 15 patients, an anterior approach with corpectomy and fusion in eight patients, and a two-stage combined approach in one patient. Overall, 21 patients experienced complete or almost complete, two patients mild, and one patient no pain relief; seven patients experienced complete neurological improvement, two patients moderate, while four patients remained stable. Overall, five patients experienced six complications including residual pain, sagittal malalignment with instability, and wound dehiscence; in five complications, a reoperation was necessary. CONCLUSIONS Palliative surgical treatment is usually performed in patients with metastatic bone disease of the cervical spine. Appropriate selection of the surgical technique is mandatory. However, the survival of the patients is dismal, and complications should be expected.