Background: Idiopathic ventral thoracic spinal cord herniation is a rare disease presented with progressive myelopathy or Brown Sequard syndrome, causing neurological deficits. There is no consensus on etiology and surgical strategy. The purpose of the present study is to report the case series using fat patch for the repair of the ventral dural defect with clinical follow up.Methods: A retrospective review of all cases of idiopathic spinal cord herniation (ISCH) at our institution was performed between January 2017 and June 2021. Clinical data were reviewed including patients' demographic information, symptoms, imaging, operative details, perioperative and postoperative courses, and clinical outcomes, and complications. Japanese Orthopedic Association (JOA) score was calculated preoperatively and postoperatively for the comparison of outcomes.Results: A total of 7 patients were included. Fat patch was applied in all cases, and artificial dural patch was also used in 2 cases. Average operating time and estimated blood loss were 3 hours and 24 minutes and 88.6 mL, respectively. Five of 7 patients improved and 2 patients remained unchanged during follow up (average, 23.4 months; range, 9-42 months). The mean recovery rate (RR) of JOA score was 17.9%. One patient experienced cerebrospinal fluid (CSF) leakage, and 1 patient suffered from surgical related spinal canal stenosis.Conclusions: Surgical treatment using fat patch is an effective strategy for the ventral dural defect repair of ISCH.