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Background Cervicothoracic junction spinal tuberculosis (CJST) in children is uncommon,especially when accompanied by a huge abscess.However,its consequences can be severe.Because of the special anatomic location of the cervicothoracic junction,surgical treatment is difficult and rarely reported.The aim of this clinical study was to assess the effectiveness of combined anterior and posterior approaches for focal debridement,decompression,allografting and anterior instrumentation in the treatment of CJST in children.Methods Ten pediatric CJST patients underwent focal debridement and cord decompression through combined anterior and posterior approaches.Then an appropriate allograft and titanium plate were applied to reconstruct the spine.The patients were asked to wear head-neck-chest braces for six months and received regular anti-tubercular drugs therapy for 12 months.Results The patients were followed-up for an average of 26 months (range,15-32 months).There was no recurrent tuberculous infection.The bone grafts incorporated well and the instrumentation was stable.Cervical and thoracic kyphosis was successfully corrected from 40° (range,30-52°) before the operation to 18° (range,12-26°)post-operation.Neurological function was improved in all patients.Conclusions Combined anterior and posterior approaches for focal debridement,decompression,bone allografting and anterior instrumentation provided an effective means of treatment in children of CJST with a huge abscess in the posterior part of the vertebral body.