Objective To research early diagnosis and treatment of acute spontaneous spinal epidural hematoma (SSEH). Methods Medical records of 13 SSEH patients adimtted in Timone Ste Marguerite Hospital,France and Ruijin Hospital,China from 1985 to 2000 were retrospectively reviewed.The etiology, neurological symptoms, neuroradiology therapy, as well as the prognosis of this rare disease are discussed in comparison with the literaturs.Results Six of thirteen SSEH wee relatd with innormal coagulation. All patients had the same original symptom which was radicular pain. Eleven cases were diagnosed by MRI. After decompressive surgery, recovery occurred in 3 of 5 patients. Five of 8 patients had a favorable outcome after medical treatment. Conclusions The majority of spontaneous hematomas results from a rupture of the venous plexus. It could be diagnosed according typical symptoms and MRI. Decompressive surgery is urgent but not unique. A idiosyncratic type which has a spontaneous complete recovery could be found.