Posttraumatic spinal epidural hematoma is an unusual pathology. The authors report the case of a 64-year-old woman who experienced thoracic epidural hematoma during a session of spinal manipulation therapy (SMT). In the literature, such an event has been reported previously only twice. This case represents the first spinal epidural hematoma occurring after a chiropractic manipulation in the lumbar region. Surgical evacuation of the spinal hematoma resulted in complete recovery in the patient. Complications of SMT are reviewed, and the etiology and features of spinal epidural hematoma are discussed.