Spinal epidural abscess constitutes a neurosurgical emergency in which early diagnosis and prompt decompression are necessary to avoid permanent cord damage. This entity is rare in premature infants and neonates in whom diagnosis can be challenging. The authors present a case of a premature twin neonate who developed an epidural abscess with complete paraparesis after coagulase-negative Staphylococcus epidermidis bacteremia that was treated with a single-level flavotomy and catheter irrigation.