Ligamentum flavum hematoma is a rare cause of root or spinal cord compression. It has been defined in the cervical, thoracic, and lumbar segments of the spine. Patients may present with the following symptoms radicular pain, hypoesthesia, loss of muscle power, and cauda equina syndrome due to the anatomic level of the lesion. Magnetic resonance imaging may provide helpful clues in the differential diagnosis of the disease. However, its diagnosis is established with intraoperative and pathological findings. Surgical decompression is the only therapeutic approach reported in the literature. Herein, we present a new case of ligamentum flavum hematoma as a possible cause of failed back in a 75-year old a man who had been operated three times before. After the last surgery, the complaints of the patient were resolved and the histopathological diagnosis was consistent with ligamentum flavum hematoma.