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Background: Spontaneous spinal epidural hematoma (SSEDH) is a rare condition with potentially devastating consequences. Known prognostic factors are short time to surgery, preoperative neurologic condition, and age. The aim of this study was to investigate the impact of the transversal hematoma extent with its subsequent spinal canal obliteration on outcome in patients with SSEDH., Methods: A retrospective study including all patients that underwent surgery due to SSEDH at the University Hospital of St. Poelten between 1/7/2005 and 30/6/2020 was conducted. The percentage of spinal canal obliteration at the level where the hematoma was most prominent was calculated and correlated to functional outcome., Results: A total of 17 patients could be included in this study. Preoperative ASIA impairment scale showed positive correlation with postoperative outcome (p = 0.005). Patients with a favorable outcome (ASIA D and E) showed a statistically significant lower mean obliteration of the spinal canal by the hematoma with 46.4% (± 8%) in comparison to patients with an unfavorable outcome with 62.1% (± 6%, p = 0.001). A cut-off of 51% yielded a sensitivity and specificity for favorable outcome of 100% and 70% respectively (area under the ROC 0.93, p < 0.001)., Conclusion: Preoperative percentage of spinal canal obliteration is statistically significant lower in patients with favorable outcome in surgically treated patients with spontaneous spinal epidural hematoma., (© 2021. The Author(s), under exclusive licence to Springer-Verlag GmbH Austria, part of Springer Nature.)