Conservative Treatment of Spontaneous Spinal Epidural Hematoma: A Report of Two Cases With Severe Neurologic Deficits and a Literature Review

Spontaneous spinal epidural hematoma (SSEH) is a rare but potentially devastating cause of acute spinal cord compression. Urgent surgical decompression is generally recommended, particularly in patients with severe neurological deficits. However, an increasing number of reports describe conservative management in patients with mild neurological deficits or spontaneous recovery. We present two cases of cervical SSEH that presented with severe neurological deficits (American Spinal Injury Association (ASIA) B) and were managed conservatively after early spontaneous neurological improvement. In addition, a review of the literature was performed, focusing on prognostic factors and the role of conservative treatment. Both patients experienced rapid neurological improvement shortly after presentation and achieved complete functional recovery without surgical intervention. Follow-up MRI confirmed complete resolution of the epidural hematoma without evidence of spinal cord injury or underlying pathology. Literature review suggests that patients with mild neurologic deficits or early neurological improvement are candidates for conservative treatment. While urgent surgical decompression remains the standard of care for SSEH with severe or progressive neurological deficits, conservative management may be a safe and effective alternative in patients demonstrating early spontaneous neurological recovery, even in cases with initial severe neurological deficits.