Spondylotic changes in the thoracic spine resulting in a myelopathic syndrome is a rare condition. Surgical treatment consists of removal of the hypertrophied ligaments, facet joints and laminae (laminectomy). In this report, we review our experience in treating 12 cases of thoracic spinal stenosis (TSS). From 1989-1998, we identified 12 surgical cases treated by the Department of Neurosurgery at Temple University Hospital. For this report, we reviewed both inpatient and outpatient records and radiographic studies. We also reviewed the world's literature regarding this entity. After reviewing our own cases of TSS and the world's literature, we identified a higher than expected incidence of acute neurologic deterioration (AND) after surgical treatment of TSS (14.5%). This incidence is compared to an expected incidence of AND (0-5.5%) after laminectomy for cervical spinal stenosis (CSS). The seemingly higher incidence of AND after surgical treatment of TSS has implications for discussion of risks with patients undergoing surgical treatment.