A modified transthoracic approach to the thoracic vertebral column is described. In this method, the parietal pleura is detached from the chest wall and retracted with the visceral pleura and its contents. A direct approach to the vertebral bodies is thus achieved without transgression of the intrapleural space. The technique can be extended to include exposure of the thoracolumbar spinal column, utilising a thoracoabdominal approach with extrapleural and extraperitoneal dissection. Management of the costophrenic detachment is thus simplified. This approach has significant advantages for orthopaedic, vascular and neurosurgical procedures.