A study of 31 cases of giant-cell tumor of vertebrae above the sacrum indicates that this unusual diagnosis is sometimes appropriate. Several entities, especially aneurysmal bone cyst and osteoblastoma, should be considered in the diffferential diagnosis. Evidence indicates that excision, sometimes with ancillary irradiation, provides a better chance for cure than would be expected with giant-cell tumor in other sites--sites where recurrent, generally large tumors develop in nearly half of the cases. Giant-cell tumors of vertebrae may affect vertebral bodies or arches and may cause irreversible damage to the spinal cord or to the emerging roots.