Early diagnosis of thoracic disc herniations has become more common with the advent of spinal magnetic resonance imaging (MRI). This early diagnosis combined with choosing the optimal surgical approach, to ensure adequate decompression without excessive cord and root manipulation, will achieve the optimum results. It is now clear that more lateral and anterior approaches to the thoracic spine are required to achieve this goal. We report our experience in the operative management of 21 patients with thoracic disc herniation using three different surgical approaches: transpedicular-transfacetal, posterolateral-extrapleural (costotransversectomy) and transthoracic-transpleural. The clinical and radiologic findings and results in all of our cases are reviewed as are the technique of and indication for each of the three surgical approaches.