Extracorporeal shock wave lithotripsy (ESWL) is a well-established, safe, and effective therapeutic alternative to surgical treatment for urolithiasis. Complications of ESWL do occur in a small number of patients, and when they do, they typically involve the kidney. Formation of a spinal epidural hematoma is an extremely rare complication after ESWL for kidney stone removal. The authors present the case of a 61-year-old man in whom a large spinal epidural hematoma developed after ESWL. They discuss the possible pathogenic mechanism of such a complication.