The authors present a case report illustrating a visceral complication that may occur as result of thoracic pedicle screw placement. The case describes the previously unreported occurrence of esophageal impingement secondary to anterior vertebral body perforation by a pedicle screw at the third thoracic vertebra. This case highlights the challenge of thoracic pedicle screw placement and the importance of preoperatively measuring the maximum anterior-posterior dimension of the vertebral body.