An 18-year-old male patient presented with pain in the nape of the neck since 12 months duration which was not improving with medication. The patient had stiffness of the neck with decreased range of movement in all directions. Routine hematological investigations were within the normal limit, and he was screened for rheumatologic problems without revealing any pathology. On magnetic resonance imaging of cervical spine [Figure 1], there were irregular lytic bony destruction in anterior arch and left lateral mass of C-1, left occipital condyle, left half of C-2 vertebra with prevertebral and left para vertebral collection, mild erosion in the odontoid process, with cranial migration of odontoid with tip up to the level of foramen magnum, there was compression of cord at this level with cord edema, suggestive of Koch's. We did a transoral decompression of abscess with biopsy along with posterior decompression of cord and occipitocervical fusion [Figure 2]. Biopsy of the pathological material shows the background of extensive necrosis and inflammatory granuloma containing lymphocytes, plasma cells, epithelioid cells, and multinucleated Langhan's type of giant cells suggestive of TB. Postoperatively, he was advised for antitubercular therapy for 18 months. Now, the patient has relief of pain and leading a normal life.