To　present　the　case　of　a　patient　on　long-term　anticoagulants　who　developed　acute　spinal　epidural　hematoma　(SEH)　after　percutaneous　kyphoplasty　(PKP)　without　signs　of　major　cement　extravasation　to　the　spinal　canal.A　64-year-old　woman　with　long-term　oral　antiplatelet　drugs　underwent　the　L1　PKP.　Immediately　after　the　operation,　the　back　pain　improved　significantly　without　neurological　deficit.　However,　12　hours　later,　she　developed　progressive　weakness　of　the　bilateral　lower　limbs.　No　intraspinal　cement　leakage　was　obvious　on　the　postoperative　lumbar　radiograph　and　computed　tomography.An　emergency　MRI　examination　revealed　a　high　signal　aggregation　in　front　of　the　spinal　cord　from　T12　to　L1,　indicating　spinal　cord　compression.　The　SEH　was　verified　and　removed　during　the　laminectomy　from　T12-L1.　Following　the　decompression　surgery,　the　neurological　deficit　of　the　lower　limbs　improved.　On　follow-up　after　6　months,　the　muscle　strength　of　the　bilateral　lower　limbs　had　returned　to　normal.For　the　patient　with　long-term　oral　antiplatelet　drugs　or　coagulation　malfunction,　the　transpedicle　approach　or　that　via　the　costovertebral　joint　with　a　smaller　abduction　angle　is　recommended　to　reduce　the　risk　of　injury　to　the　inner　wall　of　the　pedicle.　For　progressive　aggravation　of　neurological　dysfunction　after　surgery,　SEH　formation　should　be　suspected　despite　the　absence　of　intraspinal　bone　cement　leakage.　Secondary　emergency　decompression　should　be　considered　to　avoid　permanent　damage　to　spinal　cord　nerve　function　caused　by　continuous　compression.