[Abstract] Objective Retrospective analysis of clinical characteristics, potential risk factors and precautions of acute postoperative subcutaneous hematoma. Methods A retrospective analysis was done on 1522 cases ,who accepted anterior cervical surgery between Dec 2004 to Dec 2008. 25 cases developed postoperative subcutaneous hematoma after the operation, including 17 males and 8 female, with an average age of 67.7 years (range, 41～76 years). The secondary surgery was performed if conservative treatments were ineffective. Results 25 cases(1.64%) developed hematoma 3～18.4h (mean±SD, 7.7±3.2h) after the operation. In these patients, 6 cases who adopted conservative treatment received a better therapeutic effect, without further deterioration of the symptoms. Neurological function according to the JOA classification recovered from 11.5±1.9 preoperative to 12.5±1.8 postoperative, 14.2±1.0 two months postoperative. In 19 cases who suffered surgical evacuation, the clinical symptoms were markedly improved, except for 1 case of death. JOA score increased from 10.1±2.9 at admission to 11.3±2.4 at discharge, 13.2±2.6 two months postoperative. Conclusion The acute subcutaneous hematoma has a rapid progress, but does not lead to deterioration of neurological function. Conservative treatment may be effective in partial patients. The secondary surgery, the main treatment of the acute postoperative subcutaneous hematoma, should be done without hesitation if conservative treatments has no effect. It seems that the secondary surgery has no adverse effect on neurological function