Spontaneous spinal epidural hematoma (SSEH) manifests from blood accumulating in the epidural space, compressing the spinal cord and leading to acute neurological deficits. MRI provides the most valuable visualization of the location and hematoma mass as well as the presence of the spinal cord compression. SSEH can occur in any segments of the spinal cord but predominantly at the posterior cervicothoracic (C5–T2) and thoracolumbar (T10–L2) levels. The source of hemorrhage SSEH can be both vertebral venous plexus system or arterial source. Decompressive laminectomy and hematoma evacuation are the standard surgical procedures upon diagnosis of SSEH, although spontaneous recoveries have been reported. The degree of preoperative neural deficit is a major prognostic factor. Conservative management has proven effective, although feasible only if spontaneous recovery is manifested. Decompressive laminectomy should continue to remain readily available, given the inverse correlation between operative interval and recovery.