Epidural Abscess: Causes, Symptoms, and Treatment

Medically reviewed by Harsha Moole, MD, Internal Medicine. Last reviewed: October 23, 2026.

What kind of doctor treats Epidural Abscess?

An infectious disease doctor (a doctor who treats infections) usually treats this. A neurosurgeon (a brain and spine surgeon) often helps. It is a medical emergency, so care often starts in the emergency room. A direct primary care or concierge doctor can be a first stop for an evaluation and can refer you to a specialist when needed.

What is an epidural abscess?

An epidural abscess is a collection of pus (infected material) and germs. It sits between the bones of the skull or spine and the outer covering of the brain and spinal cord. The abscess causes swelling in the area.

It is a rare disorder. If it is inside the skull area, it is called an intracranial epidural abscess. If it is in the spine area, it is called a spinal epidural abscess. Most are in the spine.

Symptoms

Fever, malaise (a general ill feeling), and back pain are the most consistent early symptoms of a spinal abscess. A spinal epidural abscess may cause these symptoms:

  • Fever and back pain.
  • Trouble passing urine (urinary retention).
  • Loss of control of the bladder or bowels (incontinence).

An intracranial epidural abscess may cause these symptoms:

  • Fever.
  • Headache.
  • Lethargy (being very sleepy and low in energy).
  • Upset stomach and vomiting.
  • Pain at the site of recent surgery that gets worse, especially if there is a fever.

Nervous system symptoms depend on where the abscess is. They may include weakness. They may also include less ability to move, or loss of feeling, in any part of the body.

Causes and who gets it

A spinal epidural abscess is usually caused by bacteria (germs). It may also be caused by a fungus. In spinal cases, the most common germ is Staphylococcus aureus. Other infections in the body can lead to it, especially a urinary tract infection. Germs can also spread through the blood. Some people have no other source of infection.

Risk factors include a weak immune system (the body's defense against germs). Diabetes, alcoholism, cancer, and AIDS can cause this. Spinal procedures are also risk factors. These include epidural anesthesia (numbing near the spine) and spinal surgery.

An abscess inside the skull may be linked to chronic ear infections or chronic sinusitis (long-lasting sinus infection). A head injury or recent neurosurgery (brain surgery) can also be linked.

An abscess in the spine may be seen after back surgery or another invasive procedure on the spine. It may also be seen with bloodstream infections, boils (especially on the back or scalp), and bone infections of the spine. People who inject illicit drugs are also at increased risk.

How doctors diagnose it

Your health care provider will do a physical exam. It looks for a loss of function, such as lost movement or feeling. Once an abscess is suspected, doctors should ask a neurosurgeon for advice. Tests that may be done include:

  • A blood culture, which checks for bacteria in the blood.
  • A complete blood count (CBC).
  • A CT scan of the head or spine.
  • An MRI of the head or spine.
  • Draining the abscess and examining the material.
  • A urine analysis and culture.

Treatment

The goal of treatment is to cure the infection and lower the risk of permanent damage. Most people get antibiotics and surgery. In some cases, antibiotics alone are used.

Antibiotics are usually given through a vein (IV) for at least 4 to 6 weeks. Some people need them for longer, depending on the type of bacteria and how severe the disease is.

Surgery may be needed to drain or remove the abscess. Surgery is also often needed to lower pressure on the spinal cord or brain. This is true if there is weakness or nerve damage.

Early diagnosis and treatment greatly improve the chance of a good outcome. If weakness, paralysis (not being able to move), or changes in feeling occur, the chance of getting back lost function is greatly reduced. Permanent nervous system damage or death may occur.

When to see a doctor

An epidural abscess is a medical emergency. Call 911 or go to the emergency room if you have symptoms of a spinal cord abscess. Examples are fever with back pain, trouble urinating, and loss of bladder or bowel control. New weakness or loss of feeling also counts. So does fever with a bad headache, vomiting, or deep sleepiness.

Treating certain infections may lower the risk. Examples are ear infections, sinusitis, and bloodstream infections.

How a direct primary care or concierge doctor fits in

A direct primary care doctor charges a flat monthly fee instead of billing insurance, while a concierge doctor usually charges more and often works alongside insurance. Because this is an emergency, sudden symptoms need the emergency room first. Afterward, such a doctor can help with follow-up visits and coordinate your specialists.

Common questions

Is an epidural abscess an emergency?

Yes, an epidural abscess is a medical emergency. Call 911 or go to the emergency room if you have symptoms of a spinal cord abscess.

How long are antibiotics needed for an epidural abscess?

Antibiotics are usually needed for at least 4 to 6 weeks. They are usually given through a vein (IV).

Does an epidural abscess always need surgery?

No, not always. Most people get antibiotics and surgery. Some get antibiotics alone.

Can an epidural abscess cause permanent damage?

Yes, it can. Permanent nervous system damage or death may occur. Early diagnosis and treatment greatly improve the chance of a good outcome.

Sources

  1. MedlinePlus - Epidural abscess
  2. American Academy of Family Physicians - Spinal Epidural Abscess: A Diagnostic Challenge

Medical Disclaimer

This content is for general educational and informational purposes only and is not medical advice. It is not a substitute for professional medical advice, diagnosis, or treatment, and reading it does not create a doctor-patient relationship. Always seek the advice of your physician or another qualified health provider with any questions about a medical condition, and never disregard or delay seeking professional advice because of something you read here. If you think you may have a medical emergency, call 911 (or your local emergency number) immediately.