Near-holocord spontaneous spinal epidural haematoma: successful outcome following targeted surgical decompression

Spontaneous spinal epidural haematoma (SSEH) is a rare neurosurgical emergency characterised by the accumulation of epidural blood in the absence of trauma. Near-holocord haematoma extension is exceptionally uncommon and poses significant challenges to surgical management.A man in the 40s presented with the sudden onset of low back pain, flaccid paraplegia, urinary retention and hypertension. MRI revealed an extensive posterior epidural haematoma extending from the cervicothoracic junction to the sacrum, with maximal compression at the T11–L2 levels.Within 4 hours, the patient underwent a focused laminectomy (T12–L2, with undercutting of T11 and L3) and surgical evacuation of the clot via irrigation. Postoperative imaging confirmed satisfactory haematoma clearance. Full neurological function was restored.This case illustrates that rapid and targeted surgical decompression can result in complete neurological recovery, even in extensive cases of SSEH. Prompt MRI evaluation and early intervention remain critical to achieving optimal outcomes.