Recently, a patient who had severe back pain for more than four years and was once prepared for surgery with lumbar spondylolisthesis in the field was finally diagnosed with third lumbar transverse synovial syndrome after detailed examination, and a single injection of closure resolved most of the pain. While happy, I could not help but review this disease again to further deepen my impression. Huang Bijun of the Department of Orthopedics, Shanghai Deji Hospital, the patient’s lumbar pain was very severe, and the clinical presentation was consistent with increased pain after walking caused by lumbar instability, and the plain film also showed the objective presence of a one-time slippage of the to 45 vertebrae. However, the patient’s pressure point was very limited, not near the nerve root outlet, and the area of radiating pain was not the dominant area of the lumbar 45 segment. A closer look at the plain film revealed that the lumbar 3 transverse process was particularly long on the painful side. An injection of closure was attempted, and not much sensation was felt on the day, with significant relief the next day. So the final diagnosis was third lumbar transverse process syndrome. The transverse process of the third lumbar vertebra is exceptionally long and extends horizontally, with blood vessels and nerve bundles passing nearby and more myofascial attachments. The longer transverse process also enhances the leverage of the muscles, which have more opportunities to contract and pull and have the greatest tension, and is an important part to bear the mechanical transmission, just like the apex of the Arrow’s hard bow. Therefore, it is susceptible to external forces, and the end of the transverse process is the first to suffer when the muscles, fascia and ligaments attached to this area contract abnormally. It is easily damaged and causes tearing, bleeding, scar adhesions, and thickening and contracture of the fascia of the muscles attached to this area, causing symptoms due to friction, irritation and compression of the vascular nerve bundle. The third lumbar transverse synovial syndrome treatment, the preferred local closure treatment, as long as the fight is accurate, generally can be immediate results. Small acupuncture treatment should also be a very good choice. If the condition is recurrent and the effect of closure is not good, you can also consider doing a small surgery to remove part of the third lumbar transverse process. There are also many thoughts from this case: one would not normally think that four years of severe pain would be caused by a small transverse process of the third lumbar vertebra. If the investigation is not careful and the operation is risked, the patient’s pain will not be solved and the cost will not be mentioned, the trauma caused by the knife will never be compensated. Therefore, although it is easy to learn medicine, the practice of medicine is not easy, and to walk and cherish.