BACKGROUND: Spinal cord stimulation (SCS) is used to treat chronic pain but carries a rare risk of spinal epidural hematoma (SEH), which can cause serious neurologic injury. Urgent surgical decompression is often considered when neurologic deficits develop.

CASE REPORT: A 73-year-old man developed severe back pain during an SCS trial and was found to have a thoracolumbar SEH after trial lead removal. He remained neurologically stable during hospitalization and was managed with close observation. His pain improved, and follow-up imaging showed a reduction in the hematoma without surgery.

CONCLUSIONS: This case illustrates conservative management of SEH in a neurologically stable patient with close monitoring. Further evidence is needed to define which patients may be managed without surgical decompression.

KEYWORDS: Case report; spinal cord stimulation; spinal epidural hematoma; chronic back pain; conservative management