Radiolucent lesions of the vertebrae, especially the cervical vertebrae are commonly encountered by the orthopedic surgeons and neurosurgeons dealing with spinal column disorders. Considering the unavailability of highly sophisticated and reliable facilities to reach the exact diagnosis before starting appropriate therapy. Trial of medical therapy is suggested to be worthy before attempting for wide surgical intervention. Presenting a very interesting case, we have reviewed the lesions presenting as radiolucent areas in plain X-rays and planned a step by step discussion for differential diagnosis. Special stress has been done on the endemicity of tuberculosis and brucellosis in Iran.