A primary aneurysmal bone cyst (ABC) of the spine is a benign lesion with an aggressive nature that can lead to bone destruction and the potential of recurrence after surgical resection. This report focuses on a rare case of the primary ABC in the proximal thoracic spine that is associated with paraplegia in a 7-year-old patient. Nonetheless, the previous research has confirmed that the best therapy for thoracic lesions is challenging and the paucity of evidence-based practice remains an impediment to addressing the issue. The main attribute that leads to these difficulties is the position of the lesions that occur close to the spine and the documented relationship to deformity. Surgical resection decompression can be used alone or in combination with fixation, curettage, selective arterial embolization, and radiotherapy. This report aimed to discuss the clinical, radiological, and therapeutic features of the primary spinal ABC and stress the need for complete surgical excision and decompression if complete spinal cord injury is present. We report this rare case, which was treated surgically with excellent neurological recovery and no recurrence of the ABC at 7 months of follow-up.