Initial conservative therapy failed to control the patient’s symptoms, and given the new weakness of the left hand, which affected her daily activities, we decided to intervene surgically. The patient underwent T1/T2 left-sided partial laminectomy, and a total facetectomy with excision of the cyst followed by posterolateral fixation of C7-T3. Intraoperatively, the lesion appeared gray in color with a white capsule. Before opening the capsule, we used intraoperative electrical stimulation to identify and preserve the nerve root. Stimulation of the cyst did not produce any positive responses. At this point, we opened the capsule and a clear cerebrospinal fluid (CSF)-like liquid came out from the cyst. After resection of the cyst, the underlying nerve root was readily identifiable using electrical stimulation. The final pathology results showed fibrous tissue with nerve tissue, which is typical for perineural cysts (Figures 2-3). Postoperatively, the patient experienced significant improvement in her symptoms, represented by resolution of the shooting pain and burning sensation, as well as improved left-hand strength.