Hemorrhage from a ganglion cyst is rare and the rate of hemorrhagic incidence is less than 10%.

Although the suspected causal factors such as anticoagulation therapy, trauma, and the presence of a vascular anomaly has been proposed, the etiology of the hemorrhage from the juxtafacet cysts is still unclear.

The similar conditions differently called a ligamentum flavum hematoma, juxtafacet cyst hematoma, hemorrhagic synovial cyst and facet apoplexy have been reported ¹⁾.

Spontaneous epidural hematoma arising from the ligamentum flavum is a rare cause of acute spinal cord compression. There are only four reports in the cervical spine literature, and all were managed with surgery. Here, we describe an acute case of a spontaneous epidural hematoma arising from the ligamentum flavum in the cervical spine successfully managed without surgery.

A 69-year-old woman with a cervical spine epidural hematoma contained within the ligamentum flavum presented with paroxysmal neck pain and stiffness without a history of trauma. The magnetic resonance imaging (MRI) revealed a posterolateral epidural hematoma contained within the ligamentum flavum. As the patient was intact, she was managed conservatively with cervical orthosis. Three months later, she was symptom-free, and the hematoma resolved on the follow-up MRI study.

Spontaneous epidural hematoma arising from ligamentum flavum is a rare cause of spinal cord compression. Previous reports have described success with surgical decompression. However, initial observation and conservative management may be successful as illustrated in this case ²⁾.