Conservative management of spontaneous thoracolumbar epidural hematoma: a case report

Background Spontaneous spinal epidural hematoma (SSEH) is an exceedingly rare clinical entity often associated with neurological deficits, for which surgical intervention remains the mainstay of treatment. We report a novel case successfully managed through complete conservative therapy. Case Presentation A 59-year-old Chinese male with a medical history of hypertension, chronic smoking, and alcohol use presented to our institution with acute-onset low back pain accompanied by bilateral lower limb weakness and hypoesthesia persisting for 30 minutes. Diagnostic imaging (CT and MRI) revealed a thoracolumbar epidural hematoma (T11-L1 distribution). Contrary to conventional management paradigms, we implemented a comprehensive conservative management protoco. Remarkably, complete resolution of symptoms and spontaneous hematoma absorption were achieved within 20 days. Conclusion This case demonstrates that select SSEH cases may achieve favorable outcomes through conservative management without surgical decompression.