Synovial sarcoma (SS) is a well-defined soft tissue neoplasm often located in the extremities. Although less frequently, it can also arise in the trunk and the paravertebral localization. Adequate surgical excision is the primary treatment modality, while radiotherapy is an essential adjunct for improved local control. In this chapter, we present the case of a 50-year-old male patient with thoracolumbar paravertebral synovial sarcoma extensively involving the posterior column of the spine. While the oncological and functional outcomes following a proposed surgical treatment seemed unclear at presentation, surgery was determined to be the patient’s only chance of definitive treatment. The adjuvant modalities and surgical techniques used to achieve an oncologically safe resection while avoiding neurological and mechanical instability are described below.