Antibiotic choice should be tailored to the pathogen identified by culture Surgery should be considered for refractory and progressive infections not responding to antibiotics Epidural extension with neurologic compromise should be treated with emergent decompression and evacuation of the infection Clinical Pitfall An entity known as chronic recurrent multifocal osteomyelitis (CRMO), or nonbacterial osteomyelitis (NBO), should be distinguished from spondylodiscitis or osteomyelitis It is often associated with additional inflammatory syndromes, including peripheral arthritis, sacroiliitis, psoriasis, inflammatory bowel disease or SAPHO (synovitis, acne, pustulosis, hyperostosis, and osteitis) The etiology is poorly understood Young girls are more often affected (5:1) between the ages of to 14 years Patients are often asymptomatic between episodes, but symptoms may extend beyond months Patients may have minor diagnostic criteria of normal or mildly elevated labs (CRP, ESR), hyperostosis, other autoimmune diseases, and an associated family history Radiographic imaging can mimic osteomyelitis, but other long bones are typically involved Bone biopsies are often necessary for diagnosis and result as sterile but demonstrate evidence of inflammation and/or sclerosis or fibrosis Standard therapy involves NSAID use, but alternate medications such as oral steroids, methotrexate, and bisphosphonates, most commonly pamidronate, have been reported with positive early results Spinal Epidural Abscess The most common anatomical site for thecal sac encroachment by epidural abscess is in the cervical spine, followed by the thoracic and lumbar spine However, neurologic complications, paraparesis or paraplegia, as a result of thecal sac compression occurred more frequently in the thoracic and cervical regions The most feared complication of primary or secondary spinal epidural abscess is paralysis When paraplegia or tetraplegia is present, the prognosis is very poor POSTOPERATIVE COMPLICATIONS CLINICAL PEARLS AND PITFALLS