Spinal cavernous hemangiomas (SCH) represent a rare subtype of cavernous hemangiomas (CH). Existing literature predominantly indicates a higher prevalence of SCH in the thoracic region, although a comprehensive explanation for segmental distribution variations remains elusive. Current investigations suggest that the etiology of SCH may be linked to mutations in genes such as TEK, KRIT1, MGC4607, and PDCD10, and can also be precipitated by external factors including radiation, trauma, and infection. However, the specific impact of radiation dosage and modality on the incidence and severity of SCH warrants further in-depth study. The onset of this disease is concealed, but it can cause serious motor and sensory disorders. The symptoms mostly progress slowly or disappear gradually, but there are also cases of acute onset or sudden exacerbation. Recent research emphasizes the more prevalent magnetic resonance imaging (MRI) features of "flame-like" or "linear" intramedullary hemorrhages over the formerly identified "popcorn" or "mulberry-like" heterogeneous signals. Surgical intervention is generally recommended for patients with severe or progressively worsening symptoms, large lesion volumes, high risk of hemorrhage, or those with rapid increase in lesion size upon follow-up. Optimal outcomes are achieved when surgery is performed within three months of symptom onset. Surgical strategies typically involve laminectomy or laminoplasty via a posterior approach to achieve maximal lesion resection, although deep-seated lesions still pose considerable surgical challenges and risks. Ongoing clinical innovations are focusing on optimizing surgical approaches and techniques, such as employing anterior or dorsolateral approaches into the spinal cord via dorsal root entry zones and utilizing orthopedic robotic systems. Intraoperative monitoring technologies like neurophysiological monitoring and intraoperative ultrasound have been widely implemented, yet uniform warning criteria are yet to be established. A limited array of pharmacotherapies, including propranolol and sirolimus, have been clinically deployed, but their efficacy awaits validation from multicenter studies. In terms of disease management, patients with a history of spinal lesions, subarachnoid hemorrhages, or large lesions generally have poorer prognoses, while the impact of underlying comorbidities like hypertension and diabetes on hemorrhage risk remains unclear. The likelihood of re-hemorrhage in SCH patients increases over time, and tailored conservative treatment plans for diverse clinical scenarios are yet to be refined.