硬脊膜外膿腫，是一種嚴重的脊椎感染，可能導致嚴重神經系統後遺症。外科清創手術 治療或單獨抗生素藥物治療仍有爭議。我們報告一例金黃色葡萄球菌脊椎骨髓炎和椎間盤炎 並且合併硬脊膜外膿腫與脊髓旁膿腫。一個70歲的男性商人發生胸椎金黃色葡萄球菌脊椎骨 髓炎和椎間盤炎合併硬脊膜外膿腫與脊髓旁膿腫。他接受針劑oxacillin 兩個月治療。然後轉 換成口服dicloxacillin 繼續治療，抗生素治療的總時間為8 個月。我們建議，如果沒有接受外 科清創手術選擇選用保守治療的患者，需要密切觀察臨床症狀，監測erythrocyte sedimentation rate，和需要時候安排核磁共振或斷層掃描。如果神經學症狀有惡化，則可能需要安排緊急手術減壓治療。

Spinal epidural abscess (SEA) is a severe vertebral infection that may lead to catastrophic neurologic sequelae. The choice between surgical management and medical treatment alone for SEA is still controversial. We report a case of SEA managed with medical treatment alone at our institute. The patient was a 70-year-old male merchant who had Staphylococcus aureus spinal osteomyelitis and discitis in T8–T9 extending into the paraspinal and epidural region. He received parenteral oxacillin (2000 mg every 4 h) for 2 months, which was then switched to an oral dicloxacillin (750 mg every 6 h) after the serial follow-up erythrocyte sedimentation rate became normalized. The total duration of antibiotic treatment was 8 months. Accurate diagnosis and adequate treatment of bacterial SEA can improve outcomes. Undoubtedly, the neurological status at the time of presentation is a major factor in treatment decision making and patient outcome. The management decisions involve individual patient considerations. We hope that the decision-making algorithm presented here will be a valuable tool for clinicians.