Prognosis

Mortality due to spinal epidural abscess has declined; reported mortality rates range from 16% in a meta-analysis published in 2000 to more recent estimates of 3.7% to 11.8%, with 5 year overall all-cause mortality of 14%.[9]​[12]​[14]​​[15]​​[16]​​​ However, morbidity may be significant; patients achieving laboratory cure (normalisation of erythrocyte sedimentation rate, C-reactive protein, and white blood cell count) may have infection-related sequelae, such as recurrent local (vertebral) osteomyelitis and spinal column deformity.[9]

The single most important predictor of final neurological outcome is the patient's neurological status at diagnosis (severity and duration). A 2024 multi-centre study reported that ambulatory status, without the need for assistive devices at presentation, was the most impactful factor regarding the quality of life and functional outcomes 1 year post-treatment of SEA.[53]​ Early diagnosis is crucial, as paralysis lasting longer than 24 to 36 hours is unlikely to improve.[30]

Patients with underlying comorbidities (e.g., diabetes mellitus, intravenous drug use, or HIV infection) or with pre-existing systemic infections (e.g., infective endocarditis) are at greater risk of chronic spinal infection. In such patients, resistant or unusual pathogens (e.g., fungi) should be considered.[49][50]

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