When it comes to surgery, we Chinese people are often “stressed out”. The deeper reasons behind this phenomenon may be complex, but I think they include at least two factors: first, the mystery of surgery, and second, the fear of the risks of surgery. Here, I will first dispel its mystery. Let’s start with the rationale for surgery for thoracic spinal stenosis. Pathologically speaking, the pathogenic factor of thoracic spinal stenosis is firstly the compression of the thoracic spinal cord and secondly the instability of the intervertebral joints of the stenotic segment. When these two factors are combined, the patient’s symptoms tend to be more severe and the disease tends to progress more rapidly. Therefore, it is easy to understand that our strategy in treating thoracic spinal stenosis is to “do the opposite”: decompress the spinal cord + (when needed) restore segmental stability, a term often used by physicians: spinal cord “decompression” + intervertebral “fusion”. For patients with spinal stenosis secondary to spinal cord compression, it is important to consider whether the surgery itself may destabilize the segment, and if not, then simply “decompressing” the segment will be sufficient. Again, the content of surgery for thoracic spinal stenosis. The core of surgery is “decompression,” which literally means reducing the pressure on the spinal cord, but in fact in most patients we strive to completely relieve the pressure on the spinal cord. The process of decompression is actually the process of removing or removing the compressor from the spinal cord. For example, for dorsal compression of the spinal cord due to ossification of the ligamentum flavum, we need to remove the thoracic lamina of the corresponding segment along with the ossified ligamentum flavum to completely relax the spinal cord posteriorly; and for ventral compression of the spinal cord due to partial ossification of the posterior longitudinal ligament, if we can confirm that the narrow segment is relatively straight before surgery, the spinal cord can be displaced posteriorly after simply removing the posterior lamina of the spinal cord to avoid the ventral compression. If we can confirm preoperatively that the stenotic segment is relatively straight and that the spinal cord can be displaced posteriorly to avoid the ventral compression, we can simply remove the posterior lamina. Another common component of surgery is the “fusion” of the intervertebral joint instability, which is usually based on decompression with nail fixation of the corresponding segment and fusion with bone grafting to allow the vertebrae within the fusion area to grow together as a continuous whole and the segmental instability to be permanently resolved. Finally, the essence of thoracic spinal stenosis surgery. It is easy to see that neither decompression nor fusion directly addresses the lesions within the spinal cord in any way. It’s not that doctors don’t do anything, let alone ignore it, but it’s really “not doable”. Up to now, human medicine on earth has not advanced to the point where it is possible to surgically rehabilitate the spinal cord to the point of full recovery. On the contrary, what we have to do during surgery is to avoid touching the spinal cord as much as possible and to find ways to reduce the mechanical stimulation of the spinal cord in the process of achieving full decompression. Here is an analogy: when a casualty is pinned under a floor after an earthquake collapse, firefighters are required to lift the floor as soon as possible to get the person out, and it is common sense that firefighters will certainly move the floor to ensure the safety of the casualty and avoid secondary injuries as much as possible. During surgery for thoracic spinal stenosis, the orthopedic surgeon plays the role of the “fireman” who lifts the “vertebral plate”, and the result of the surgery is that the spinal cord is “saved” and is no longer under pressure. The result of the surgery is that the spinal cord is “saved” and no longer under pressure, but the injury caused by the long-term pressure needs to be slowly rehabilitated at home. It should be added that the application of minimally invasive techniques in thoracic spinal stenosis surgery is still in its infancy, and there are currently (2015 AD) some minimally invasive technical methods for the treatment of thoracic spinal cord compression due to thoracic disc herniation, but there are no minimally invasive treatments for thoracic ligamentous ossification and posterior longitudinal ligament ossification in clinical settings worldwide.