A spontaneous spinal epidural hematoma (SSEH) is a rare disease that accompanies severe axial pain in the spine with various levels of paralysis depending on the location of the hematoma. A SSEH is mainly caused by a coagulating disorder or anticoag-ulants medication, while certain cases relate this disease with spinal inflammatory conditions. The early diagnosis of a SSEH is important for its treatment. Most cases with neurologic symptoms can be treated with a immediate laminectomy and decompression. If the neurologic symptoms improves within 12 hours, a conservative treatment is effective, however few cases have been reported. We encountered a 59 years old male without a prior medical history suffering from severe back pain and paraplegia due to a SSEH at thoracic vertebrae. The patient was successfully treated conservatively. We report this case with a review of the relevant literature.