Spontaneous SEAs are classified as primary (PSEA) and secondary (SSEA). PSEAs arise directly, most often in the dorsal epidural space, without involving the vertebrae, via hematogenous or lymphatic spread [3]. SSEAs develop per continuitatem from spondylodiscitis or a paravertebral abscess.

In the materials and methods, Chen et al. [1] state that prior spinal surgeries and spinal infections were excluded from the study, but it is unclear whether this refers only to recurrent spinal infection after surgical intervention, since epidural abscesses and spondylodiscitis are themselves spinal infections.

It is not clear what indications guided the choice among the three surgical techniques used, which would be important for establishing future therapeutic approaches in similar cases. PSEAs rarely cause segmental instability, unlike SSEAs, and therefore almost always require only decompression. The relatively long interval between symptom onset and diagnosis, as well as the fact that 51% of patients had a SITE score ≤6, suggest that these cases involved SSEAs, since they exhibited erosion of end plates or vertebral bodies, leading to segmental instability. It is not clear in which cases long-segment instrumentation was used and in which cases short-segment instrumentation was applied. Most likely, the choice of instrumentation type was determined by the number of affected vertebrae and the severity of vertebral body destruction. We fully agree with Chen et al. [1] that the different infectious agents (pyogenic or tuberculous), the severity of the disease, and patient status—which determined the type of intervention—may have influenced the outcomes.

The minor clarifications we have made in no way diminish the value of the publication by Chen et al. [1], which not only verifies the SITE score for predicting the outcome of surgical treatment of spinal epidural abscesses, but also definitively establishes the threshold score, for which we would like to congratulate them.