Pure spinal epidural cavernous hemangioma with contralateral symptoms is rarely reported. It will be very difficult to diagnose when it is complicated by contralateral symptoms. A 56-year female presented with pure lumbar epidural cavernous hemangioma with contralateral symptoms. Physical examination and imaging including X-ray, CT and MRI, suggested that it is a hemangioma complicated by spondylolisthesis. Laminectomy and exploration was performed. Postoperative X-ray showed satisfactory interbody fusion and reduction of spondylolisthesis. The patient was fully recovered four months postoperatively. Histopathological examination showed that the mass was epidural cavernous hemangioma.