Methicillin-resistant Staphylococcus aureus (MRSA) cervical spinal subdural empyema a a result of a retropharyngeal abscess has not been reported previously. We present a 65- year-old male intravenous drug user who developed spinal subdural empyema after an operation for a retropharyngeal abscess. Although imaging diagnosis and follow-up surgery were performed quickly. the neurological outcome was poor. We review the literature on retropharyngeal abscess with intraspinal infection