Spontaneous spinal epidural hematomas are a rare consequence of long-term anticoagulant therapy. Their physiopathology remains poorly understood. This pathology carries a significant risk of morbidity. The purpose of this article is to report a case of a massive spontaneous spinal epidural hematoma extending on multiple levels, detailing the surgical technique used in its evacuation described for the first time in literature. This is a case report of an 80-year-old patient on anticoagulant therapy with a thoracolumbar spontaneous spinal epidural hematoma extending from T1 to L1 vertebrae. We share the clinical and radiological presentations, the surgical treatment, outcome and follow-up. The diagnosis of spontaneous spinal epidural hematoma has to be considered in patients with acute brutal onset radiculo-medullary compression. Medullary magnetic resonance imaging (MRI) remains the exam of choice. Medical and surgical treatment must be started immediately after the diagnosis is confirmed. The prognosis remains poor despite a proper management, with debilitating complications.