Presents as a triad of pain, fever, and progressive limb weakness. Aching pain is almost always present, either over the spine or in a radicular pattern. The duration of pain prior to presentation is generally <2 weeks but may be several months or longer. Fever is usually present along with elevated white blood cell count, sedimentation rate, and C-reactive protein. Risk factors include an impaired immune status (diabetes mellitus, HIV, renal failure, alcoholism, malignancy), intravenous drug abuse, and infections of skin or other soft tissues. Most cases are due to Staphylococcus aureus; other causes include gram-negative bacilli, Streptococcus, anaerobes, fungi, and tuberculosis.

MRI localizes the abscess. Lumbar puncture (LP) is required only if encephalopathy or other clinical signs raise question of associated meningitis, a feature found in <25% of cases. The level of the LP should be planned to minimize risk of meningitis due to passage of the needle through infected tissue.