We reported an operated case of spontaneous ventral epidural hematoma of the cervical spine. A 55-year-old male was admitted to our hospital because of sudden back pain and subsequent tetraplegia. On admission he was alert, and the laboratory data were normal. Urgent MRI indicated ventral spinal epidural hematoma at C4-C5 levels that was compressing the cord posteriorily. Six hours after onset we performed laminectomy as a posterior decompression to avoid evacuation of the venous hematoma. MR images 3 weeks after the operation revealed only a very thin mass at the ventral side and the compression of the spinal cord was dramatically improved. Postoperative spinal angiogram was performed to investigate the etiology of bleeding, but there were no specific findings such as venous angioma or arteriovenous malformation. About 1 month after the operation he was discharged with a complete neurological recovery except dysesthetic sensation in the right big toe. In the literature, the majority of these lesions were located dorsally and only 7 reported cases were located in the ventral side. Immediate decompressive surgery has been commonly accepted. We concluded that it is not always necessary to evacuate venous hematoma, and that acute staged laminectomy as posterior decompression is important.
