Spinal epidural abscess is a potentially life-threatening disease that can cause paralysis by the accumulation of purulent material in the epidural space. Although modern diagnostic and management methods have improved the prognosis, morbidity and mortality remain significant. Outcome usually is determined by the rapidity of the diagnosis and initiation of appropriate treatment. A high index of suspicion is warranted when a patient presents with spinal pain or a neurologic deficit in conjunction with fever or an elevated erythrocyte sedimentation rate. Gadolinium-enhanced magnetic resonance imaging should be done in suspected cases to localize and define the abscess. For spinal epidural abscess associated with neurologic compromise, the treatment of choice is emergent surgical decompression and débridement (with or without spinal stabilization), followed by long-term antimicrobial therapy. In the absence of a neurologic deficit, medical management is an alternative to surgery when the risk of neurologic complications is low based on the location and morphology of the abscess, immune status of the patient, and virulence of the organism.