Objective To investigate the clinical manifestations and diagnosis and treatment of spontaneous spinal epidural hematoma. Methods A retrospective survey of 5 patients with spontaneous spinal epidural hematoma diagnosed in our spine orthopedics from 2014 to 2017 was performed. The patient''s epidemiological materials, clinical features, laboratory tests, imaging findings, and treatment methods were recorded to evaluate treatment outcomes and prognosis. Results There were 2 males and 3 females with an average age of 69.8 years. The spontaneous hematoma occurred in 1 patient in the cervical segment and 4 in the thoracic and thoracolumbar segments. ASIA grade, 3 patients with grade A, 1 patient with grade C, and 1 patient with grade D. According to the MRI staging of hematoma, 1 of the 5 patients had a hyperacute phase, 1 had a subacute early stage, and 3 had a subacute late stage. Three patients underwent laminectomy and hematoma evacuation, and two patients underwent conservative treatment. All patients were followed for at least 1 year. At the last follow-up, the patients had an ASIA score, 1 grade A, 1 grade B, and 3 grade E. Conclusion Spontaneous intraspinal epidural hematoma should be diagnosed and treated early to prevent the optimal timing of delay in treatment.