The presentation and outcome of pediatric cervical spine tuberculosis are different from those of adult cervical spine tuberculosis. We retrospectively reviewed the clinical and radiographic outcome of 58 children with cervical spine tuberculosis treated nonoperatively and operatively between 1996 and 2004. The mean age was 3.7 years (range, 1.9-14 years). The cervicodorsal junction was affected in 27 children, the atlantoaxial complex in 19 children, and the mid-cervical spine in 12 children. Multifocal noncontiguous spinal lesions were observed in 21 patients. Surgery was performed in 25 children for: neurologic deficit (14); drainage of retropharyngeal abscesses (four); atlantoaxial fusion for late C1-C2 instability (three); and progressive deformity and pain (four). Neurologic recovery occurred in all patients. Seven patients were lost to followup within 2 years. The minimum followup was 2.4 years (mean, 3.5 years; range, 2.4-10 years). We attributed the improved functional outcome after anti-TB chemotherapy alone to the remodeling potential of the pediatric cervical spine. Surgery was performed only for neurologic deficit, an atlantodental interval greater than 5 mm on flexion/extension view, and progressive deformity. Four patients developed superficial wound infection, two patients had graft repositioning for a slipped graft, and seven children developed a grade 1 pressure sore over the scalp while on traction.