In spite of advances in medical knowledge, imaging techniques, and surgical interventions, the diagnosis and treatment of spinal epidural abscess remains a challenge. The diagnosis is often elusive, but achieving diagnosis prior to the onset of neurological defi cits is essential to preserving the vital neurological function. Traditionally, urgent surgical decompression and drainage remain the mainstay therapy for spinal epidural abscess. In recent years, with the improvement of antibiotics,conservative treatment with adequate antibiotics has been proposed as an effective method in selective patients. We report a case of spinal epidural abscess in a 50-year-old man, who complained of progressive weakness of lower extremities for 4 days before admission. After conservative treatment with antibiotics alone, the patient recovered uneventfully from previous neurological defi cits. The relevant literature is also reviewed.