Management of metastatic disease is a significant challenge in modern spinal surgery. Previously, radiation therapy alone was the most commonly employed treatment. Recent data, however, suggest that surgical decompression in addition to radiation therapy improves functional recovery compared with radiation therapy alone. Metastatic disease most commonly affects the thoracic spine. Over the past decade surgical treatment has changed significantly for thoracic disease, shifting from transthoracic resection and reconstruction to single-stage posterolateral approaches that allow transpedicular resection and reconstruction. In posterolateral approaches, patients are spared the morbidity associated with transcavitary approaches while receiving the benefit of radical resection and circumferential reconstruction in a single-stage procedure. The authors report 3 cases in which a similar posterior transpedicular technique, adapted for the cervical spine, was used for intralesional resection of metastatic tumors of the axis.