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Spinal Epidural Abscess. Spinal epidural abscess is an infection in the epidural space. Patients typically present with localized back or neck pain (or both) that is accompanied by fever or neurologic symptoms. Magnetic resonance imaging with contrast enhancement is the diagnostic test of choice. An accurate microbiologic diagnosis is important and can be made with blood cultures, with tissue and fluid cultures obtained by image-guided needle aspiration or biopsy, or at the time of surgery. Staphylococcus aureus is the most frequent pathogen, causing more than 50% of infections. All patients with spinal epidural abscess should be promptly evaluated by a spine surgeon and an infectious-disease specialist. Many patients with spinal epidural abscess undergo surgery, although antimicrobial therapy alone may be curative in carefully selected patients.