One of the hardest findings to spot on a radiograph is the finding that isn't there. In this case, this lateral view of the neck shows one less vertebral bodies than spinous processes.
Congenital disease can certainly cause unusual vertebral anomalies.
However, this gentleman is in some pain, which should make us entertain some more active and acquired process before writing it off to a congenital process. This should, in turn, bring to mind entities that can destroy a vertebral body. In this case, so much that we can no longer see the C3 body at all. This represents an extreme case of vertebra plana. The diagnosis is made much easier by looking at other radiographs, as shown below.