The risks of thoracic spinal stenosis surgery are bound to be of high concern to both doctors and patients. Relatively speaking, patients have limited information and face greater difficulties in judging the risks of surgery, so it is necessary to introduce them here. 1.Risks related to systemic conditions The body may originally have some diseases (such as coronary heart disease, hypertension, diabetes, etc.) that break out or worsen during or within a short period of time after surgery, such as acute myocardial infarction in patients with coronary heart disease and acute cerebral hemorrhage in patients with hypertension, which can be life-threatening in severe cases. Or these pre-existing conditions lead to new problems, such as poor wound healing due to poor glycemic control in diabetic patients, or pulmonary embolism due to venous thrombosis in the lower extremities. These aforementioned problems should be focused on by the doctor during the preoperative examination and preoperative preparation, and the condition of the combined disease can be detected or evaluated through the necessary tests. Through the efforts of the doctor, the patient’s physical condition can be adjusted to the optimal level, thus minimizing the risk in this regard. 2. Risks directly related to surgery It is well known that the risk of surgery for thoracic spinal stenosis is considerably higher than that of surgery for cervical and lumbar spine related disorders, especially its paralytic rate. The reasons for this phenomenon are complex, and one of the most important factors is one of the anatomical characteristics of the thoracic crestal medulla: the relative weakness of the blood supply. The relative weakness of the blood supply to the thoracic crest medulla has two consequences: (1) the resistance of the thoracic crest medulla to blows is relatively low, and a very slight external force may lead to serious damage to the thoracic crest medulla; (2) the ability to repair damage to the thoracic crest medulla after it occurs is relatively low. It is like planting crops, some land is not lack of water or fertilizer, while some is dry and barren, these factors will definitely affect the final harvest. 3.Factors affecting the risk of surgery The blood supply of the crestal medulla of the middle and upper thoracic segments is relatively weaker than that of the crestal medulla of the lower thoracic segments, so the risk of surgery of the middle and upper thoracic spine is higher than that of the lower thoracic spine. In thoracic spinal stenosis caused by ossification of the posterior longitudinal ligament, the ossified mass compresses the crestal medulla from the anterior aspect of the crestal medulla, requiring ligation of the corresponding segmental vessels from the lateral anterior approach or posterior circumferential decompression during surgery, and the risk of surgical secondary paraplegia is more than ten times higher than that of thoracic spinal stenosis caused by ossification of the ligamentum flavum. The number of segments of spinal stenosis also affects the risk of surgery, which is relatively low in single-segment cases, but can be 5 or 10 segments in multi-segment cases, and in a few cases, from the first thoracic vertebra all the way to the 12th thoracic vertebra, which inevitably increases the risk associated with surgery exponentially. Doctor’s note: Thoracic spinal stenosis surgery is considered one of the most challenging and risky procedures in crestal surgery. Patients and families need to be fully aware of this prior to surgery. To paraphrase the words of our ancestors, patients with thoracic spinal stenosis should “prepare for the worst while making the best of it”!