Vertebral canal haematoma (VCH) is a rare but serious complication of neuraxial anaesthesia, particularly in patients with coagulopathy, difficult epidural placement, or anatomical abnormalities. This article explores the pathophysiology, risk factors, clinical presentation, and management of VCH. Symptoms include progressive motor weakness, bowel/bladder dysfunction, and severe back pain, often requiring urgent neurological assessment. MRI is the gold-standard imaging modality, and timely surgical decompression within 8 h is crucial for optimal recovery. Prevention strategies focus on adhering to anticoagulation guidelines and ensuring careful procedural technique. Early recognition and multidisciplinary management are essential to prevent permanent neurological deficits.