Clinically significant spinal epidural hematomas (SEHs) are rare in spinal surgical procedures. We present a 63-year-old female with a history of hemodialysis for 11 years who received surgical treatment because of pronounced radiculopathy caused by degenerative lumbar spine disease. The outcome of surgical decompression was satisfactory at first, but symptoms recurred four days after the operation. The symptoms were initially treated conservatively but severe back pain developed. A follow-up magnetic resonance imaging scan two weeks after the operation revealed a spinal epidural hematoma, which had compressed the thecal sac over the decompression site. The epidural hematoma was removed and the patient recovered. In this report we discuss a clinically significant subacute SEH that developed after a spinal surgical operation in a uremic patient. The mechanisms responsible for postoperative SEHs in uremic patients are also discussed.