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Primary osseous leiomyosarcoma of the spine is an extremely rare entity with only 13 previous cases having been reported in the literature. We present the case of a 57-year-old woman with a tumor of the eleventh thoracic vertebra, causing compression of the spinal cord. Histopathology and immunohistochemical results of the tumor biopsy specimen disclosed a primary leiomyosarcoma of the thoracic spine. We report on the features of this rare entity but also review and summarize the imaging and pathology characteristics that can be extrapolated from the existing literature. [ABSTRACT FROM AUTHOR]