We enjoyed reading the case report entitled "Brown tumor of the cervical spines: a case report with literature review" by Alfawareh et al. [1]. We would like to commend the authors for their detailed and valuable work.

Brown tumor, an uncommon focal giant cell lesion, is a nonneoplastic and reactive process that occurs due to bone resorption and localized benign clinical osseous lesions appearing as a skeletal manifestation of primary or secondary hyperparathyroidism. Spinal involvement (cervical, thoracic, and lumbar spine) with brown tumor (osteoclastoma) in patients with hyperparathyroidism, although rare, may be the initial manifestation of HPT [12].

However, we believe that some important additional comments are necessary. In the article, the authors stated that there are only four cases of cervical spine involvement reported, three of which are of secondary hyperparathyroidism. Only one reported case involves the axis, the second cervical vertebra, in secondary hyperparathyroidism. To their knowledge, theirs was the first reported case of axis brown tumor due to primary hyperparathyroidism, the second reported case for cervical spine involvement of primary hyperparathyroidism and the fifth reported case of cervical spine brown tumor [1]. Nevertheless, we would like to call the attention of the readers to the fact that the literature contains additional case reports related to cervical spine brown tumor (Table 1) [1234567891011].

Again, we appreciate the work by the authors, which adds to our knowledge of this difficult clinical problem.