A 54-year-old male presented with intense lumbar pain, erectile dysfunction, urinary and fecal incontinence, hypoesthesia of the genital and perianal regions, and decreased muscle strength and sensitivity in the lower extremities. The patient had a clinical history of hypertensive cardiac disease, chronic kidney disease (KDIGO G3b), proliferative retinopathy, right transmetatarsal amputation due to diabetes mellitus type 2, left radical nephrectomy due to stage III clear cell renal adenocarcinoma (T2bN1M0), and a right renal abscess. On physical examination, he presented with bilateral lower limb strength of 4/5, bilateral decreased patellar and Achilles reflexes, hypoesthesia in S3–S5 dermatomes, abolished cremasteric reflex, urinary retention, and decreased anal sphincter tone on digital rectal examination. A spine magnetic resonance imaging (MRI) reported T12 spondylodiscitis with decreased height and posterior wall retropulsion, an epidural collection with severe canal narrowing and conus medullaris compression, as well as left parasagittal epidural and retrocrural collections. The patient was admitted for percutaneous drainage of the left paravertebral abscess, which isolated pan-sensitive Staphylococcus aureus. Despite receiving a complete intravenous antibiotic scheme, clinical deterioration, fever, and elevated C-reactive protein occurred. A new MRI and positron emission tomography-computed tomography (CT) reported the persistence of T12 spondylodiscitis with dissemination to soft tissues and T11-L1 vertebral bodies, destruction of both pedicles, intracanalicular extension of prevertebral collections with spinal stenosis, and displacement of the spinal canal. Collections were identified in both psoas muscles and the left diaphragmatic crura. Surgical treatment was decided; a T12 corpectomy and instrumentation with an expandable cage supplemented by lateral plate and bicortical screws through a minimally invasive lateral approach was performed. Clinical and radiological improvement was observed during the next two weeks. Nevertheless, at the control MRI, after two weeks, a right postero-basal pleural empyema was observed. A enhanced chest CT scan showed right pleural effusion with gas content. Due to the proximity of the empyema to the neurosurgical site, a 99mTc-UBI 29–41 SPECT/CT was performed [ and ] to rule out infection of the instrumentation hardware. The study reported a spinal column infection at T11-L1 that did not compromise the neurosurgical site. Thoracocentesis, video-assisted thoracoscopic surgery, and surgical drainage, plus a high-spectrum antibiotic scheme, were done. Following the completion of antibiotic treatment and favorable clinical evolution for two weeks, the patient was discharged. An external consult followed the patient, and has not presented a recurrence of the condition.