A 59-year-old lady with a known history of intravenous heroin abuse, arterial hypertension, and chronic hepatitis C, presented to our emergency department with severe thoracic back pain and progressive spastic paraparesis of her lower extremities. The patient had a past history of aT7/T8 spondylodiscitis with epidural abscess, and failed conservative treatment by intravenous antibiotics at an outside institution, where the patient had been initially treated with nafcillin 10 g i.v. for 6 weeks. Due to unsuccessful eradication, the antibiotic regimen was then adapted changed to cefazolin 1 g i.v. twice daily for 6 weeks. An emergent MRI on the day of admission to our emergency departments showed a kyphotic wedge compression fracture at T7/T8 with significant spinal cord compression and myelopathy. She was taken to surgery the same day for a right-side anterolateral thoracotomy, radical surgical debridement, anterior corpectomy T7 and T8, discectomy T6/T7, T7/T8 and T8/T9 and anterior spinal canal decompression, prevertebral and epidural abscess evacuation. Spinal stabilization from T6 through T9 was performed by vertebral body replacement using an expandable titanium cage (Synthes Synex® cage), autologous bone graft, and an anterolateral locking plate system (Synthes). There were no intra-/perioperative complications and the patient tolerated the surgical procedure well. Her postoperative course was uneventful, and the neurological impairment recovered within two weeks. She was fitted in an adjunctive TLSO brace and discharged on day 12 after clearance by physical and occupational therapy. Intravenous antibiotics were adjusted according to the intraoperative culture results and continued through a Hohn catheter on an outpatient basis with vancomycin 1 g i.v. per day for 6 weeks The patient followed up in clinic at regular intervals, showing an uneventful recovery with progressive ambulation, decreased back pain, and well-healed surgical wounds without any signs of a residual infection. Six months after the procedure, she presented again to the emergency department, secondary to a repeat fall, with clinical signs of acute paraplegia of the lower extremities. Emergent radiographic evaluation by conventional films and CT scan revealed a failure of fixation of the anterior thoracic spine, with a cranial pull-out of the cage and locking plate in the coronal plane, and kyphotic malunion in the sagittal plane. The patient was taken back to the OR for revision surgery the next day. A posterior instrumentation was performed from T2 through T11 (Stryker Xia® polyaxial internal fixator system) with correction of the kyphotic malunion and posterolateral bone grafting. The failed anterior fixation was revised through the previous right-side anterolateral thoracotomy, by removal of the failed expandable cage and anterolateral locking plate, revision debridement of a recurrent epidural abscess, and revision fixation from T4 through T9 using a titanium mesh cage (Stryker, V-Boss® cage) filled with PMMA/Tobramycin cement. Despite the successful salvage procedure, the patient deteriorated in the postoperative phase in the surgical intensive care unit (SICU). She developed bacteremia, meningitis, sepsis and eventually a septic shock. Blood cultures were positive for Methicillin-sensitive S. aureus, and the patient developed a P. aeruginosa pneumonia, leading to acute respiratory distress syndrome (ARDS). A spinal tap further revealed positive cerebrospinal fluid (CSF) cultures for E. coli, implying a gram-negative bacterial meningitis. Intravenous antibiotic therapy was continued and modified according to the culture sensitivity testing with vancomycin 1 g i.v. per day Standard supportive SICU care was continued for management of ARDS and septic complications. Ultimatively, the patient developed a secondary abdominal compartment syndrome which led to impaired ventilatory capacity and the requirement for an emergent decompressive laparotomy. Within two weeks of spinal revision surgery, the patient succumbed to these postoperative complications, as a consequence of refractory septic shock with multiple organ failure.