Five methods of direct approach to the thoracic and lumbar vertebral bodies have been presented. In each instance, the surgeon should select that procedure which is safest for the particular vertebral body involved. By approaching the vertebral body directly through definite bone channels which can be readily exposed, the selected portions of the body contents are made available for diagnosis and subsequent therapy. These methods are particularly valuable in those cases in which the lesion is confined to the vertebral body, and no other sources of biopsy or culture material are available upon which to base a diagnosis. Moreover, the direct approach facilitates the introduction of penicillin, streptomycin, or other medication into the vertebral body.