The surgical management of the pathologies at the cervicothoracic junction is hindered by various structures. Standart approaches to the cervical or thoracic spine provide inadequate exposure. We used a method which involves elevation of the medial comer of the manubrium,the stemodavicular joint and medial half of the davide on a pedide of the sternodeidomastoid musde for a tuberculosis abcess of Tl vertebra. After surgery neurologic functions improved and the patient had pain relief.