Background: Acute spontaneous spinal epidural hematoma (ASSEDH) is rare and its treatment standard were set prior to the era of magnetic resonance imaging (MRI). Recent data provided by this new technique necessitate a critical review of these standards.
Methods: A case of ASSEDH diagnosed by MRI and confirmed at surgery is presented. In addition, all cases of ASSEDH reported in the pertinent literature since 1987 were reviewed and compared with those cases described earlier.
Results: Since the introduction of MRI, the mean incidence of ASSEDH cases reported in the literature has increased from 2.2 to 6.4 new cases per year, with a remarkable rise in the percentage of those cases that did not require surgical treatment from 1.5% before the era of MRI to 29% thereafter.
Conclusion: ASSEDH runs a benign course more often than previously estimated and, therefore, the choice of the treatment should be decided for each case individually. Urgent surgical decompression remains the treatment method of choice for patients with ASSEDH presenting with disabling neurologic deficit.