En bloc excision is strongly recommended for management of a spinal giant cell tumor (GCT) because of the high local recurrence rate associated with intralesional excision. We perform total en bloc spondylectomy (TES) with transpedicular osteotomy using a T-saw, which allows the posterior elements of the spine to be removed en bloc and allows for easier dissection of the spinal cord and nerve roots. Although T-saw transpedicular osteotomy often involves an intralesional procedure, we feel that TES with inclusion of the tumor margin will result in curative resection. All 11 patients with a spinal GCT who underwent TES with intralesional T-saw transpedicular osteotomy at our hospital between May 1994 and February 2015 had no local tumor recurrence or metastasis at a mean follow-up of 108 months (range, 24 to 216 months). Concern exists with regard to the highly invasive nature of TES for management of a spinal GCT; therefore, the benefits of the procedure must be weighed against the associated perioperative morbidity. Initially, TES frequently required more than 10 hours and often was associated with blood loss exceeding 2,500 mL. The surgical techniques for TES have improved greatly as a result of the knowledge acquired and consideration of the surgical anatomy, physiology, and biomechanics of the spine and the spinal cord. In five patients with a spinal GCT who recently underwent TES, intraoperative blood loss was 252 ± 171 mL without the need for blood transfusion, and no perioperative complications occurred. This video shows current surgical techniques for TES of a spinal GCT, with a focus on safety and reduction of intraoperative blood loss.