In spine surgery, minimally invasive approaches (MIS) are getting accepted and more popular worldwide during the last decades. It is due to the reduced intraoperative blood loss, decreased infection rate, less postoperative pain and earlier discharge from hospital compared to traditional approaches. The present paper puts forward a minimally invasive extrapleural approach to the thoracic spine that is not applied in Hungary. This new approach, in contrast to the standard costotransversectomy, provides direct visual control over the ventral surface of the dural sac. Furthermore, contrary to the transthoracic way, following minimally invasive extrapleural surgery thoracic drainage and intensive care are not necessary. The approach can be applied safely in treatment of ventral or ventrolateral pathologies of the thoracic spine.