Toothpaste artifact of the spinal cord is generally known as artificial and morphological change in the field of neuropathology. It is considered that while the spinal cord is pressed on local parts with some solid bodies, the inner spinal tissue pressed penetrates into the weak vicinity of pressed parts and consequently pencil-shaped morphological change, toothpaste artifact, occurs. We report an autopsy case with toothpaste artifact of the spinal cord. A 77-year-old man, who was a front-seat passenger and was injured to the vertebra in a traffic accident, complained suddenly of dyspnea and precordial oppression during a rest on bed in a hospital 18 days after laminectomy, and he died of pulmonary embolism originated in thrombi in the deep veins of lower extremities. The toothpaste artificial change of spinal cord was microscopically observed at the near site of laminectomy. Slight bleeding was observed in a margin of the slipped area, but there was no reactive change. In present case, external compression of spinal cord which occurred accidentally during the period after the operation or at cardiopulmonary resuscitation seems to have caused the toothpaste artifact. © 2009 Elsevier Ireland Ltd. All rights reserved.