Gyawali, DSharma, MRPradhananga, AShrestha, Piya E2026-04-212026-04-212017https://hdl.handle.net/20.500.14572/5843D Gyawali Chirayu National Hospital and Medical Institute, Basundhara, Kathmandu, Nepal MR Sharma Chirayu National Hospital and Medical Institute, Basundhara, Kathmandu, Nepal A Pradhananga Chirayu National Hospital and Medical Institute, Basundhara, Kathmandu, Nepal Piya E Shrestha Chirayu National Hospital and Medical Institute, Basundhara, Kathmandu, NepalAbstract The authors report on a 70-year-old woman with a synovial cyst compressing the thecal sac at L level. The patient presented with severe, unremitting back pain radiating to both buttocks of three months duration. Her general physical and neurological examination was largely normal. The patient underwent magnetic resonance imaging which revealed a right sided extradural cystic lesion at L4-5, level with a significant thecal compression. Given the imaging evidence of space occupying lesion and severe symptoms refractory to analgesics and physical therapy, surgery was performed. She underwent bilateral L5 laminectomy and complete excision of the cystic lesion. The histopathology was compatible with the diagnosis of synovial cyst. She had uneventful postoperative period and discharged home pain free on postoperative day 4. This case highlights the importance of investigating an underlying disease process in patients who present with significant back pain and offering the tailored treatment to individual patients with spinal synovial cysts.en-USArticle