Many surgical approaches have been defined and implemented in the last few decades. The best Imatinib mechanism method for thoracic disc herniation is still controversial. Except for the laminectomy method that has been abandoned lately, a comparison of the results obtained by studies on various surgical methods indicates that 60 to 80% of the patients recover from the pain or improve their neurological picture. Posterior laminectomy and/or discectomy is the first method used in surgical treatment of thoracic disc herniation [12]. By using this method, it is difficult to decompress midline disc pathologies attached to the dura. The risk of morbidity is high, and even paraplegia may develop. Furthermore, it contains the risk of late kyphotic deformity development [13, 14].

This method has now become historic, and it is not anymore used as a surgical treatment approach for thoracic disc herniation [15]. Transpedicular approach, transfacet pedicle sparing approach, costotransversectomy, and transfacet/transforaminal approach are listed among posterolateral approaches [16�C23]. Perot Jr. and Munro [14] described the transthoracic approach in 1969 and in 1988 Bohlman and Zdeblick recapitulated this approach. This technique provides access to all levels under T4. It provides direct visibility in central, paracentral, and lateral pathologies [24]. The method proves to be effective in soft and hard pathologies, and it has high efficacy in multilevel pathologies [25]. The method presents high rates of complications such as atelectasis, pleural effusion, and pneumonia, which is a disadvantage.

If the surgeon has to free the diaphragm, hernia may develop. Large arteries or venous structures may be damaged, and left-side approaches bear the risk of infarct and impaired blood supply to the spinal cord due to the obstruction of Adamkiewicz artery. However, Mulier and Debois indicated that even though pulmonary complications may be observed unlike lateral and posterolateral approaches, this approach yielded better neurological improvement [26]. Otani et al. described transthoracic extrapleural approach to reduce the risk of pulmonary complications [27]. The advantages of anterior video-assisted thoracoscopic approach include minimal dissection, low morbidity, no need to retract for rib resection, short hospital stay, and short rehabilitation period.

The biggest disadvantage is that Batimastat the surgeon should be particularly trained to perform this approach. In their study involving 29 patients, Regan et al. reported 76% satisfactory results [25]. Transforaminal endoscopic discectomy is among the methods applicable for thoracic disc disease. It may be used not only for far lateral and foraminal discs but also in midline discs [28]. Transforaminal endoscopic discectomy (TFD) has increased success rates in eligible patients. Computed Tomography helps to discover the bone structure at the preoperative stage.