Seventy-five-year female patient with diabetes, hypertension and hyperthyroidism visited our clinic for left shoulder radiating pain. In cervical radiologic study, multiple nodules were seen on both lung fields. In chest MDCT, active pulmonary tuberculosis and miliary tuberculosis were suspected and mass on 1st and 2nd thoracic vertebral body with destruction was seen. In cervico-thoracic MRI, 1st thoracic vertebral pathologic fracture was found. Miliary tuberculosis with spinal tuberculosis was diagnosed with right middle lobe biopsy. After 3 weeks with chemotherapy, lesion got advanced on MRI and radiating pain got worse. We performed 1st thoracic vertebral corpectomy with auto iliac bone graft, after 1 week posterior instrumentation was performed. After surgery, radiating pain and weakness got better, the patient is followed up at the outpatient. In general, spinal tuberculosis treats with antituberculous agent at first. But, if spinal deformity or neurologic symptom was accompanied, surgical correction will be necessary. In this case, advanced cervico-thoracic spinal tuberculosis with conservative therapy was treated 1st thoracic vertebral corpectomy with auto iliac bone graft and posterior instrumentation. The patient’s neurologic symptom was got better after surgery.