Neurosurgical care of spinal epidural, subdural, and intramedullary abscesses and arachnoiditis

Epidural abscess of the spinal column is a rare but potentially devastating disease. When recognized early and treated appropriately, the outcome can be excellent. Abscesses in the spinal subdural space or in the spinal cord proper are even more unusual but can also lead to complete and irreversible loss of neurologic function if not diagnosed and treated rapidly. Although infection frequently can result in arachnoiditis, there are other more common causes, such as surgery and chemical irritants. It remains a difficult condition to treat, and long-term therapeutic results are mediocre. Newer technology with spinal cord stimulation seems to show improved results but pain relief is incomplete, and the percentage of patients with poor results remains high.