Introduction: This study aimed to investigate the clinical management and outcome of patients with spontaneous spinal epidural hematoma (SSEH) and clarify the appropriate treatment and characteristics of SSEH.

Methods: We retrospectively reviewed ten patients with SSEH who were treated at our hospital between January 2014 and September 2021. The patients were divided into surgical and conservative treatment groups (S and C groups, respectively), and the difference in etiology, image findings, and treatment outcomes between the two groups were investigated.

Results: The patients included four females and six males, with a mean age of 71.2 (62-84) years. Of the ten patients, six were treated surgically (S group) and four conservatively (C group). In the C group, all the patients showed dramatic improvement in neurological deficit within two hours following onset, whereas the patients in the S group displayed no improvement on the day of the onset. All the patients in the C group and five patients in the S group regained walking ability after a month, while two patients in the S group did not. Three patients (two in the S group, one in the C group) had been undergoing hemodialysis. Five hematomas were located in the cervical lesion and two in the thoracic lesion. Thoracic hematomas were both observed in the S group. Three patients were administered with antithrombotic medication, and five patients showed high signal changes (HSCs) in the spinal cord during MRI. These findings were exclusive to the S-group.

Conclusions: Conservative treatment is effective in patients who show an early improvement in neurological deficit, whereas those with no improvement should undergo surgical treatment. The patients with hematomas in the thoracic lesion, HSCs in the spinal cord detected by MRI, and a history of antithrombotic medication may require more attention.