CASE REPORT Open Access Spontaneous spinal epidural hematoma of the thoracic spine after herbal medicine: a case report Eo Jin Kim 1 , Joonghyun Ahn 2 and Seung-Ju Kim 1* Abstract Background: Spontaneous spinal epidural hematoma (SSEH) is an uncommon disease, but it can lead to acute cord compression with disabling consequences. Identifiable reasons for spontaneous hemorrhage are vascular malformations and bleeding disorders. However, SSEH after taking herbal medicines has not been described yet. Case presentation: A 60-year-old female experienced sudden back pain combined with numbness and weakness in the lower limbs for several hours with no trauma, drug use, family history or any disease history. Her deep tendon reflexes were normoactive, and Babinski was negative. An emergent MRI showed a spinal epidural hematoma extending from T3 to T5. She was taken to surgery after immediate clinical and laboratory evaluations had been completed. Emergency decompression with laminectomy was performed and the patient recovered immediately after the surgery. Additional history taken from the patient at outpatient clinic after discharge revealed that she had been continuously taking herbal medicine containing black garlic for 8 weeks. Conclusion: To our knowledge, no report has been previously issued on SSEH after taking herbal medicines. Although contradictory evidence is present on bleeding risks with herbal uses, we believe that it’s reasonable to ascertain if patients with SSEP are taking herbal medication before or during spinal surgery. Keywords: Spontaneous spinal epidural hematoma, Surgical treatment, Herbal medicines, Black garlic, Spinal cord Background Spinal epidural hematoma (SEH) is an idiopathic aggre- gation of blood in epidural space which can be as acute, chronic, spontaneously, post traumatic, or iatrogenic [1]. SEH occurring without a trauma is called as spontan- eous SEH (SSEH) and it is an uncommon neurosurgical emergency which can lead to acute cord compression with disabling consequences [2]. The incidence of SSEH was estimated to be 0.1 patients per 100,000 populations per year [3]. As SSEH is one of the potentially reversible pressure lesions on the spinal cord and roots, its prompt diagnosis and treatment have a vital importance [1]. Al- though some nonsurgical treatments have been reported in cases that neurologic deficit improves in the early phase of disease [1], early surgical decompression (Laminectomy) is the first-line treatment modality for SSEH [4, 5]. The etiology of SSEH remains unknown; however, some predisposing factors have been reported, including long term aspirin use as platelet aggregation inhibitor, anticoagulant therapy for prosthetic cardiac valves, therapeutic thrombolysis for acute myocardial infarction, hemophilia, factor XI deficiency, vascular malformation, Paget’s disease and pregnancy [6–8]. However, to the best of our knowledge, no report has been previously is- sued on SSEH after taking herbal medicines. Here, we report a case of a 60-year-old woman who presented with SSEH after taking herbal medicines and treated successfully by surgical decompression. Case presentation A 60-year healthy female who was a hospital janitor of our institute visited an emergency department with a one-hour history of sudden low back pain with lower ex- tremity motor and sensory deficit aggravated by bending. * Correspondence: sju627@hotmail.com 1 Department of Orthopaedics, Hanil General Hospital, 308 Uicheon-ro, Dobong-Gu, Seoul 132-703, South Korea Full list of author information is available at the end of the article © The Author(s). 2018 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. Kim et al. BMC Complementary and Alternative Medicine (2018) 18:291 https://doi.org/10.1186/s12906-018-2354-y