A 72-year-old female presented with the upper back pain of 6 months’ with one month of acute worsening associated with the onset of paraparesis (i.e., 3/5 deficit). Laboratory studies showed; a serum calcium level of 144 mg/L (normal: 90–105 mg/L) and a slightly high parathyroid hormone level (pg/mL; normal is 10–53 pg/mL). A thyroid ultrasound proved negative, but the parathyroid scintigraphy with Tc-99 m showed focal activity in the inferior right thyroid lobe consistent with a parathyroid adenoma. Both the CT and MR studies showed BTs compressing the cord from T3 to T5 secondary to hyperparathyroidism. The thoracic CT demonstrated multiple osteolytic lesions of the vertebral bodies and posterior elements from Th3 to Th5 level []. The thoracic MR thoracic revealed a large expansile T3–T5 vertebral mass with extradural extension resulting in significant cord compression; it was isointense on T1, and hyperintense on T2-weighted images []. Following an emergent Th3-5 laminectomy, the extradural mass was totally excised, and the cord was adequately decompressed. The histopathological examination confirmed a BT secondary to hyperparathyroidism. Postoperatively, the patient’s symptoms resolved within 3 weeks. Subsequently, she was referred for a parathyroidectomy.