The incidence of compression fractures is increasing in aging populations. Differentiating pathological fracture types is complex and requires careful consideration during diagnosis. This case report describes the clinical course of a 54-year-old female patient presenting with progressive paraplegia after a back injury sustained while lifting a heavy object. Initial imaging revealed a burst fracture at T12 and severe spinal cord compression due to an epidural mass extending from T12 to L2. Clinical assessment raised suspicions of a hematologic malignancy or pathological fractures. Laminectomy and spinal fusion, along with mass removal, resulted in partial improvement in motor function and patient-reported pain levels. However, further evaluation and biopsy revealed chronic inflammation with fibrosis consistent with an unresolved hematoma. This case underscores the importance of a comprehensive differential diagnosis and multidisciplinary collaboration, integrating radiologic, surgical, and pathologic correlation, in the management of complex spinal pathologies.