Spontaneous spinal epidural hematoma (SSEH) is an unusual cause of spinal cord compression, requiring emergency diagnosis and treatment. We report a case of SSEH, and discuss its early diagnosis and rapid surgical intervention. A 46-year-old man was brought to our emergency department because of sudden-onset, rapidly-progressive paraplegia and acute
urinary retention. Magnetic resonance imaging revealed an epidural mass lesion in the posterior epidural space from T9 to T11 in the spinal canal. The patient underwent emergency decompression laminectomy within 4 hours of symptom onset and recovered fully within 1 week. In patients with SSEH, early surgery is crucial to ensure a favorable outcome.