Thoracic spinal stenosis is an uncommon pathologic condition of the spine. This chapter reviews its etiology, epidemiology, anatomic features, symptoms, diagnosis, and treatment. Four of the main causes of thoracic spinal stenosis are ossification of the ligamentum flavum, ossification of the posterior longitudinal ligament, thoracic disc herniation, and thoracic spondylosis. Even rarer secondary causes include generalized skeletal disorders, metabolic and endocrine disorders of the spine, neoplastic lesions, and vascular malformations. The chapter presents a brief review of the currently available surgical techniques. An updated review is provided of the literature on non-surgical management of the disease, mainly interventional pain management.