The authors report five patients with thoracic spinal intramedullary hemangiomas that have undergone surgery between 1989 and 1999. Subjects comprised two men and three women, with a mean age of 47 years. Two patients had sudden onset of severe low-back pain, and three had chronic onset. The tumor was totally removed in four patients, and partially removed in one. Intramedullary hemorrhage was found in all patients at operation. In follow-up studies (range 6 months to 3 years, mean 1.5 years) neurological function improved in three patients, remained unchanged in one, and worsened in one. Magnetic resonance imaging was useful in the diagnosis of spinal intramedullary hemangioma.