Objective: To examine the presentation, investigative findings, treatment and outcome in patients with spinal epidural abscess.Design and setting: The study was a retrospective analysis of all patients with this condition presenting to the Neurosurgical Units at the Royal Prince Alfred Hospital and Westmead Hospital, Sydney, during the period September 1984 to September 1987.Patients: There was a total of 21 patients with an age range from 7‐‐87 years (mean 47 years). Eleven cases were acute and ten chronic. The causative organism wasStaphylococcus aureusin 15 of the 21 cases, the other organisms involved wereMycobacterium tuberculosis, Escherichia coli, StreptococcusandPseudomonas aeruginosa.Interventions: All patients were treated with a combination of surgery (decompression with or without fusion) and prolonged antibiotic administration.Results: Of the 21 patients 11 had a good to excellent outcome while 10 had a poor outcome.Conclusion: The main determinant of outcome was the neurological state at presentation emphasising the importance of early diagnosis and prompt treatment.