In a series of 12 cases of thoracic disc herniation operated upon at the University of Pittsburgh, 4 different operative approaches were used. These included laminectomy in 2 early cases, posterolateral extrapleural operation in 5 cases, transthoracic operation in 3 cases, and transpedicular operation in 2 cases. The relative merits of the various approaches are discussed in this paper. The clinical presentation, radiological features, and follow-up data are also presented. Precise preoperative radiological diagnosis was essential in planning the operative strategy. The posterolateral and transpedicular approaches were both satisfactory, but the former had some advantages over the latter. With a mean follow-up period of 5 years, 5 patients were cured, 5 were improved, and 1 was unchanged. One patient was worse due to coexistent amyotrophic lateral sclerosis.