The anterolateral approach is useful for accessing ventral pathologies of the thoracic and thoracolumbar region. Accurate anatomic knowledge leads to better surgical results, decreasing complications of unnecessary and potentially catastrophic injuries. Anterior approach for decompression and instrumentation produce predictable and favourable outcomes in terms of neurological recovery and pain relief as seen in our study. Operative intervention through the anterior approach allows adequate debridement of tuberculous granulation tissue and cold abscess. This together with immobilisation of the diseased segment of the spine offers better chances for the success of post operative medical therapy. The anterior approach with vertebrectomy followed by spinal stabilisation for patients with metastatic spinal disease facilitates the surgical removal by optimising exposure in the diseased spinal segment. Anterior approach also allows early decompression, control of pain, and with appropriate knowledge and experience of the technique leads to lesser operative time and blood loss. The familiarity and experience of the surgeon with the approach will always remain a cornerstone for the success of the procedure.