The authors believe that it is not possible to remove a thoracic vertebra completely by a lateral transthoracic approach. They have operated on three patients in which a thoracic vertebra has been removed completely using an extended posterior approach. The technique described utilizes an extra-pleural bilateral thoracotomy through a single posterior incision. The posterior mediastinum is mobilised and the vertebral bodies freed. The technique is indicated in tumours of the spine compressing or threatening the spinal cord, especially primary local malignant tumours or where adjuvant treatment such as radiotherapy, chemotherapy or radio active drugs are effective. Benign but recurrent tumours such as giant cell tumours or aneurysmal bone cysts are also good indications for this method.