A spinal epidural abscess is an accumulation of pus in the
epidural space that can mechanically compress the spinal cord.
Spinal epidural abscesses usually occur in the thoracic or
lumbar regions. An underlying infection is often present; it may
be remote (eg, endocarditis, furuncle, dental abscess) or
contiguous (eg, vertebral osteomyelitis, pressure ulcer,
retroperitoneal abscess). In about one third of cases, the cause
cannot be determined. The most common causative organism is
Staphylococcus aureus, followed by Escherichia coli and mixed
anaerobes. Occasionally, the cause is a tuberculous abscess of
the thoracic spine (Pott disease). Rarely, a similar abscess
occurs in the subdural space. Symptoms and Signs Symptoms begin
with local or radicular back pain and percussion tenderness,
which become severe; pain may be worsened by recumbency. Fever
is common. Spinal cord compression may develop; compression of
lumbar spinal roots may cause cauda equina syndrome, with
neurologic deficits resembling those of con