Fibrous dysplasia involving the thoracic spine is very rare. This patient had monostotic fibrous dysplasia involving the vertebral body, posterior elements, and right seventh rib with focal neurologic signs. The radiographic and bone scan findings are shown. The patient was treated successfully with tumor resection and arthrodesis using combined anterior and posterior approaches. Although fibrous dysplasia is classified as a benign process, clear margins of resection are required to prevent recurrence.