Brown tumors may occur secondary to hyperparathyroidism in patients with chronic renal failure (CKD). They are increasingly rare because hyperparathyroidism in now diagnosed and treated at an early stage. We report 67-year-old man who had been on hemodialysis for CRF for over 3 years, who presented with back pain over the thoracolumbar junction from 2 years ago and because of pain he could not stand or walk in the last 3 months before surgery. Ambulation was regained after surgical decompression and stabilization. In conclusion, when brown tumor arises in the spine, surgery may be needed to preserve neurologic function.