Objective To explore the clinical features of spontaneous spinal epidural hematoma (SSEH) and to find out factors influencing its prognosis. Methods From September 1998 to October 2006, 23 patients with SSEH (10 males and 13 females) were treated. Their ages ranged from 10 to 69 years. The primary neurological status were classified as grade A in 7 patients,B in 2 patients, C in 4 patients, D in 9 patients and E in 1 patients accordingto ASIA grading system. The progressive intervals of their symptoms were divided as four period: less than 12 hours (12 patients), 12 to 24 hours(2 patients), 24 to 48 hours(3 patients) and more than 48 hours(6 patients). SSEH was diagnosedby MRI or by histopathological examination. The cases history, laboratory examination, radiological image, treatment, pathological result and prognosis were recorded and analyzed after 3 month. Results In 23 patients, there were 1 case of deterioration, 8 cases of no change, 9cases of improvement and 5 cases of complete recovery. The gender had no correlationwith prognosis(P＞0.05). In the patients who had shorter progressive interval and more severe edema of spinal cord, the prognosis was worse(P＜0.05). Inthe patients who had mild neurological deficit, the prognosis was good (P＜0.01). In 17 patients undergoing surgery, the scores for prognosis was 1 point in 1 case, 2 points in 5 cases, 3 points in 6 cases and 4 points in 5 cases; the operation time had no correlation with prognosis(r=0.056, P＞0.05). In6patients undergoing conservative treatment, the scores for prognosis were 2 points and 3 points in 3 cases respectively. Conclusion Prognosis of patient with SSEH is influenced by his primary neurological status, progressive interval, spinal edema and size of hematoma. The major treatment is surgical evacuation of hematoma as early as possible to break the aggravation of spinal function. Conservative treatment is not considered unless the neurological defects recovered in the early period.