Abstract: Objective To compare the effects of discectomy with lateral anterior approach and lateral posterior approach on the efficacy, trauma and prognosis of patients with thoracolumbar disc herniation, in the hope of providing a basis for the reasonable choice of surgical approach. Methods Total 136 patients with thoracolumbar disc herniation to be treated by discectomy in our hospital from January 2016 to March 2019 were selected as the research objects, who were randomly divided into group A and group B with random number table method, 68 cases in each group. In the selection of surgical approach, the group A adopted lateral anterior approach, and the group B adopted lateral posterior approach. The information of perioperative period was recorded, and followed up for 6 months. The Visual analogue score (VAS) and Oswestry disability index (ODI) of the two groups were compared, and the complications was observed. Results The hospital stay of group B was (10.81±2.04) d, shorter than that of group A (13.57±2.79) d, intraoperative blood loss was (550.18±32.27) mL, less than group A (746.81±23.29) mL, the drainage volume was (144.75±30.92) mL, less than group A (214.01±21.89) mL, and the differences were statistically significant (t=6.593, 40.738, 15.076, all P<0.001). All patients were followed up, the VAS score and ODI index of the two groups at 1 and 6 months after the operation were significantly reduced compared with those before the operation, the change trend was the same. All patients successfully completed the operation, the symptoms were significantly relieved, and there were no neurological complications and recurrence cases, the incidence of complications in group B was 11.76%, significantly lower than 25.00% in group A (P<0.05). Conclusion The treatment of thoracolumbar disc herniation by lateral anterior approach and lateral posterior approach can achieve satisfactory results, and the latter has advantages in reducing surgical trauma and complications, which is worthy of clinical attention.