A 15-year-old female acutely presented with the right lower extremity paresis (2/5), a D4 sensory level, bilateral lower extremity hyperreflexia/bilateral Babinski responses, and urinary incontinence. Laboratory studies were unremarkable. The thoracic CT showed an expansile destructive lesion involving the left lamina of D2-5 and left pedicle/spinous process of D4. The accompanying ventral amorphous calcific mass extended from D2-5 level. This resulted in circumferential cord compression and paraparesis [ and ]. The MR noncontrast and contrast-enhanced studies similarly documented circumferential tumor involvement from the D3-D5 levels. Tumor involved the posterior elements of D3, D4, the body of D4, and there was an additional posterior epidural mass extending all the way from D2-5. The latter resulted in epidural cord compression and high T2 intramedullary cord signal from D2-5 [ and ]. The whole-body bone scan showed tumor involving D2 and D3 vertebral bodies. The patient underwent a left sided laminectomy from D2-D5. This allows for epidural tumor resection, additional removal of the left D4 pedicle, and pedicle screw/rod fixation at D3, D5, and D6. The tumor was vascular, soft, and partially calcified. The histopathological examination showed pleomorphic spindle cells that produce disorganized osteoid, consistent with an osteosarcoma [-]. The patient underwent a second trans-axillary thoracotomy (right) with removal of the 3rd and 4th ribs. This allowed for D4 body resection and D3-D4 and D4-D5 discectomies. This was followed by the anterior placement of an autogenous D3-D5 iliac crest graft [-]. At the second surgery, the osteosarcoma tissue appeared more vascular []. After a second opinion, reviewed specimen and immunohistochemistry confirmed the diagnosis. The patient underwent adjuvant chemotherapy [ and ]. Now 15.5 years later, the patient’s follow-up CT [ and ] and bone scan show no tumor recurrence. Further and her presenting monoparesis has resolved and she has just mild residual spasticity.