Spontaneous spinal epidural haematoma is a rare condition that may lead to spinal cord or cauda equina compression resulting in severe neurologic impairment. Predisposing factors include anticoagulation, vascular malformation, disc herniation. Both surgical and more recently conservative modes of treatment have been described in the literature. This is the first reported case of a successful conservative management and follow-up of a spontaneous spinal epidural haematoma in a 90-year-old patient. The patient presented with acute onset of back pain and weakness of the legs. The patient was treated conservatively and made a complete recovery. Haematoma resolution was confirmed with a repeat magnetic resonance imaging scan.