Abstract:Spinal epidural abscess and subdural empyema are uncommon in a general neurosurgical practice. Despite the availability of improved imaging studies and a greater awareness, the mortality rate remains high. Patients with spinal epidural abscess and subdural empyema commonly present with back pain that may rapidly progress to weakness or paralysis if untreated. The key to successful treatment is prompt diagnosis and implementation of timely and effective treatment. Patients with spinal pain and fever should raise a suspicion for an epidural abscess or subdural empyema. Magnetic resonance imaging (MRI) is the most appropriate imaging study, and if an abscess is present in a patient with a progressive neurologic symptoms, the patient should undergo urgent surgical decompression and debridement. However, a few selected patients with no neurologic deficit and a known pathogenic organism that is sensitive to antibiotics have been successfully treated without surgery. A 4-week to 8-week course of intravenous antibiotic treatment is usually necessary, and with early intervention, the prognosis is often good.