A 26-year-old female student presented with 5-month history of upper back pain and 4-day weakness in the arms and legs with numbness from the chest down. Neurologically she had decreased sensation below T7, grade 4/5 power in the upper limbs, 3/5 power in the lower limbs with brisk reflexes, and increased tone and clonus. Weight loss in the past few months was noted, but there was no fever or productive cough. She was not immunised for tuberculosis and did not have family history positive for tuberculosis. MRI showed a paraspinal abscess from C7-T1, with collapse of the vertebral body and cervical cord compression. A mini transsternal approach, anterior C7-T1 vertebrectomy with decompression of the ventral sac, was performed. Reconstruction was achieved with a mesh, iliac bone graft, and an anterior plate. A week later patient received a C5-T4 posterior fixation for stability, which allowed early mobilisation of the patient. At 1-year follow-up her Frankel grade improved to grade E.