A 54-year-old male presented with spontaneous acute epidural hematoma in the ventral cervical spine. The neurological deficits gradually improved spontaneously before surgery commenced. Serial magnetic resonance imaging demonstrated disappearance of the hematoma. He was managed conservatively and was discharged without deficits about 1 month after onset. Immediate surgical decompression may not be necessary if neuroimaging and clinical examinations suggest that spinal epidural hematoma will resolve spontaneously.