Surgical Decompression in a 32-Year-Old Man with Chronic Onset of Thoracic Spontaneous Spinal Epidural Hematoma: A Case Report

BACKGROUND Thoracic spontaneous spinal epidural hematoma is a rare acute neurological disorder that occurs in the epidural space between the dura mater and the vertebrae, typically in the thoracic region. Its etiology is often unclear, and it can compress the spinal cord, leading to progressive neurological deficits. Immediate diagnostic evaluation and intervention are crucial to prevent lasting impairments. This report describes a case of a 32-year-old man with spontaneous thoracic epidural hematoma who underwent surgical decompression treatment. CASE REPORT A 32-year-old male Asian patient presented with gradually worsening chest and back pain, along with lower-limb weakness. Despite receiving over 2 months of acupuncture treatment at a local hospital, his symptoms showed no improvement, prompting him to seek further evaluation at our hospital. Following physical examination and MRI, he underwent laminectomy and decompression, with a diagnosis of thoracic spontaneous spinal epidural hematoma. On the second postoperative day, he reported complete resolution of chest and back pain, with significant improvement in bilateral lower-limb weakness. He was fully recovered at the time of discharge, and follow-up over the next year revealed no abnormalities. CONCLUSIONS The degree of postoperative neurological recovery is determined by the duration of surgical delay and the extent of preoperative neurological damage. Physicians should consider spontaneous epidural hematoma in the differential diagnosis when managing patients with chest/back or neck pain, particularly when there is no clear history of trauma or coagulation abnormalities, using MRI/CT for further evaluation. Prompt surgical intervention is essential once neurological deficits are observed.