Rationale:Epidural hematomas can develop following intrathecal puncture, spinal vascular malformation, or spontaneous hemorrhage. Prompt recognition of symptoms and referral to neurosurgical services are crucial for recovery. We report a rare case of delayed removal of an epidural hematoma that resulted in good patient outcomes.Patient concerns:A 69-year-old woman weighing 58 kg presented with back pain that had persisted for 12 years. Her medical history was notable for hypertension. Cervical computed tomography angiography indicated a giant abdominal aortic aneurysm measuring 11.58 × 17.34 × 13.00 cm in her abdominal cavity. Stent graft implantation was scheduled by the interventional therapy group to treat her abdominal aortic aneurysm under single-dose spinal anesthesia. Postoperatively, the patient complained of numbness and swelling of her lower extremities, with progressive paralysis developing in both legs accompanied with sensory disturbances.Diagnoses:Delayed magnetic resonance imaging detected an epidural hematoma.Interventions:Eighty hours after the onset of sensorimotor symptoms, lumbar decompression and removal of the hematoma were performed via laminectomy under general anesthesia.Outcomes:The patient was discharged 2 months after the operation with a 3/5 score on the Muscle Strength Grading System.Lessons:Laminectomy may be effective in achieving a good prognosis despite a considerable delay in diagnosis.