Hemangioma is one of the most common benign tumors of the spine, and it remains silent in the vast majority of the subjects afflicted. Pregnancy is a known risk factor for symptomatic conversion of the previously dormant vertebral hemangiomas. However, the occurrence is rare with only 24 cases reported in the literature. The authors present a case of vertebral hemangioma symptomatic during the third trimester of pregnancy. The patient, a 20-year-old woman in her 33rd week of pregnancy, initially presented with acute back and bilateral leg pain, and developed the cauda equina syndrome within a week of its onset. Imaging studies revealed an L2 vertebral hemangioma, and the thecal sac was severely compressed by the epidural portion of the tumor. Emergency decompression and reconstruction surgery was undertaken 3 days after an uneventful cesarean section. The combined surgical management, consisting of laminectomy, intraoperative vertebroplasty, and segmental fixation, afforded adequate decompression, instant mechanical stability of the spine, and prompt pain elimination. The long-term efficacy of this combined treatment is unclear and needs to be followed cautiously.