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 (normalization 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 neurologic outcome is the patient's neurologic status at diagnosis (severity and duration). A 2024 multicenter 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 posttreatment 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 preexisting 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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