Herniated thoracic discs, unlike their lumbar counterparts, are difficult to read and safely resect using traditional posterior approaches. Historically, the use of a laminectomy for thoracic disc resection has yielded poor clinical outcomes. Posterolateral and anterolateral approaches have become the standard surgical means of treating these lesions. The traditional anterolateral approach, the transpleural thoracotomy, is an extensive procedure that requires direct retraction of the lung, a deep surgical field, and postoperative closed-chest drainage. An alternative to this anterior approach, the retropleural thoracotomy, is described here. This approach provides the shortest direct route to the thoracic spine and leaves the pleura intact. A smaller incision and less retraction than traditional approaches may reduce postoperative pain and pulmonary-related complications. The retropleural thoracotomy is a valuable technique for the neurosurgeon treating thoracic disc disease.