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Spinal muscular atrophy (SMA) is a rare lower motor neurone disease in which anesthetic management is often difficult as a result of muscle weakness, hypersensitivity to non-depolarizing neuromuscular blocking agent, and succinylcholine induced hyperkalemia. We describe a 50-year-old patient with type IV SMA for synovectomy. We decided to use an epidural technique to avoid muscle relaxants and tracheal intubation. After operation, there was no exacerbation of neurologic signs and symptoms. (Korean J Anesthesiol 2010; 59: S65-S68) Key Words: Epidural anesthesia, Spinal muscular atrophy. Epidural anesthesia for the patient with type IV spinal muscular atrophy-A case report