Since the first publication on spinal gout by Kersley GD et al in 1947, there has been considerable research, but it is still rarely encountered in clinical practice and is easily misdiagnosed. We describe in this report a patient who had spine gouty arthropathy at both the cervical and the thoracic level of the spine with myelopathy which prompted surgery at these 2 levels. To our knowledge, there has never been a reported case of spine gout in 2 separate levels of the spine. A man with chronic kidney disease, had gradual worsening weakness and sensory impairment below the waist within half a year. This 64-year-old was mainly managed for his lower limb weakness and subsequently due to concurrent cervical myelopathy symptoms, planned MRI. Imaging revealed lytic punched out lesion at C5-C6 vertebrae and an erosive extradural mass at T9-T12 with bony destruction, initially suggestive malignancy. He then underwent an emergency decompressive laminectomy and posterior instrumentation for the mid spine, and anterior cervical corpectomy C5-C6 and fusion. Intra-operatively, chalky white tophaceous material was found evidently compressing the dura at both levels, which histopathologically was reported as gouty tophi. Post-operatively, treatment for gout was commenced and in subsequent months of follow-up delightfully he had regained partial neurological recovery. Although rare, gout when present may cause debilitating condition that may mimic malignancy, hence a high index of suspicion is required, even in patients without an established diagnosis of crystal arthropathy.