Spinal extradural perineural cysts were initially described by Tarlov . They are classified as type II meningeal cysts , most frequently found in the sacrum and very rarely in the thoracic spine. They are also known as spinal nerve root diverticula or ‘Tarlov perineural cysts’ . Incidental cysts are usually managed expectantly, but the treatment of symptomatic cysts is controversial . Here, we present a case of a symptomatic thoracic nerve root perineural cyst treated with surgical excision.