<p>To explore the reasons for misdiagnosis of “atypical” thoracic spinal stenosis and improve clinicians’ diagnostic ability to distinguish such conditions, in order to prevent misdiagnosis and missed diagnoses.&#xa0;A retrospective review of 245 cases of thoracic spinal stenosis admitted to our department between May 2013 and May 2020, of which 15 were “atypical” thoracic spinal stenosis cases. These included 10 males and 5 females, aged between 41 and 74 years, with an average age of 61.2 years. The duration of clinical symptoms was an average of 3.5 years. During this time, patients were frequently misdiagnosed, resulting in ineffective treatment and symptom progression. Clinical manifestations of the “atypical” thoracic spinal stenosis varied, including 4 cases presenting with persistent abdominal pain, 4 with unilateral persistent chest and back pain, 4 with unilateral lower limb numbness and pain, and 3 with intermittent claudication. Preoperative JOA scores for these patients ranged from 4 to 10, with an average of 7.26.&#xa0;After detailed history taking, physical examination, and appropriate imaging studies, all 15 patients were diagnosed with thoracic spinal stenosis and underwent surgical decompression. Follow-up was performed for all 15 patients, with a follow-up period ranging from 4.7 to 11.7 years (average 8.2 years). Of these, 12 patients showed significant symptom improvement, while one patient, who had concomitant spinal arthritis, still experienced persistent lumbar stiffness post-surgery. Postoperative JOA scores ranged from 7 to 11, with an average of 9.46, and the recovery rate of neurological function was 69.6%. Of the patients, 12 had excellent outcomes, 2 had good outcomes, and 1 had acceptable outcome.&#xa0;“Atypical” thoracic spinal stenosis presents with diverse clinical symptoms. A thorough understanding of its clinical features and heightened awareness is crucial for accurate diagnosis, thus avoiding misdiagnosis and missed diagnoses.</p>