Objective To explore the curative effect and clinical application of thoracolumbar epidural cyst fistula repair combined with cyst tail end technique. Methods This paper reviews 12 cases of thoracolumbar spinal canal spinal epidural cyst fistula repair combined with cyst tail end technique (after resection of the cystic sac of the caudal end of the cyst the small incision at the junction of the tail end of the cyst and the normal dura mater) by electrophysiological monitoring microsurgery. Results During 14 months of follow-up ,9 cases of imaging cysts disappeared completely, most of them disappeared in 1 case ,2 cases of residual cysts in intervertebral foramen, none of them had dural sac compression There was no recurrence. There were 11 cases of low back pain and / or lower extremity pain before operation. The pain was relieved or disappeared at discharge. There was no significant difference between the pain change and discharge after 3 months follow-up. The lower limb weakness and dysuria gradually recovered, and no new neurological deficit appeared after operation. There were no cases of spinal stenosis and deformity.Conclusion Electrophysiological monitoring microsurgical thoracolumbar spinal canal epidural cyst fistula repair combined with cyst tail end technique can effectively solve the problem of living flap and close cyst. At the same time, the spinal stability caused by surgery was reduced and scarred spinal stenosis was prevented by laminectomy. This method is the same principle as intraspinal tumor resection repair and suture of rigid spinal membrane, no obvious complications, clinical feasibility.