OBJECTIVE AND IMPORTANCE: Spontaneous thoracic spinal cord herniation (STSCH) is an uncommon cause of thoracic myelopathy. Fewer than 40 cases have been reported in the English language literature with a mean follow-up of less than 6 months. CLINICAL PRESENTATION: We have encountered three patients diagnosed with STSCH in the last 6 years at our institution. These patients presented with symptoms and signs localizing to the thoracic spinal cord. Magnetic resonance imaging revealed ventral thoracic spinal cord displacement in each. INTERVENTION: One patient was treated surgically, two managed expectantly. Two patients have been followed for greater than 5 years, whereas a third has been followed for 15 months. CONCLUSION: Our experience suggests that patients with neurological symptoms and signs attributable to STSCH may not progress and therefore may be followed with clinical and magnetic resonance imaging surveillance. When surgery is indicated for progressive STSCH, late retethering may occur.