Provided herein is a method for treating spinal stenosis comprising percutaneously accessing the epidural space from a first side of the spine. The first side of the spine is located on one side of the medial plane with respect to the spinal cord. A tissue removal tool is then advanced through the first side of the epidural space into the other side of the epidural space, where the other side of the epidural space is located on the other side of the medial plane of the spinal cord. Once the tissue removal tool is located on the second side of the medial plane, stenosis can be reduced using the tissue removal tool.