The authors describe a case of spinal cord compression due to an osteochondroma arising from the T-6 vertebral body in a patient with hereditary multiple exostoses. This 16-year-old boy presented with spastic paraparesis. Surgical decompression was followed by resolution of the neurological impairments. Osteochondroma is the most common bone tumor. The distribution of osteochondromas greatly favors the extremities and these lesions rarely arise in the vertebral column. Osteochondromas occur in 2 distinct clinical settings--as solitary or multiple tumors, the latter being often associated with hereditary multiple exostoses. Osteochondromas are more commonly found in the posterior elements of the vertebrae. Intraspinal presentation of these tumors is usually limited to the cervical regions, with few tumors reported in the thoracic vertebrae. Based on the presented case and literature review, the authors conclude that osteochondromas of the thoracic spine that cause myelopathy usually arise from the vertebral body and pedicle. Prompt and systematic radiological investigations are important in planning surgical management. Surgical excision usually yields good results.