Spondylodiscitis and epidural abscess after spinal surgery: case series highlighting diagnostic and therapeutic challenges

Objective: To describe the clinical, radiological, microbiological, treatment, and functional characteristics of three patients with postoperative spondylodiscitis (SD) and/or spinal epidural abscess.Methods: We retrospectively reviewed postoperative SD/EA cases managed at a regional hospital between 2019 and 2023. Patients with previous spinal surgery, magnetic resonance imaging (MRI)-confirmed SD with or without EA, and at least 3 months of follow-up were included. Demographic characteristics, imaging findings, microbiological results, treatment approaches, and clinical outcomes were evaluated.Results: Three patients (54–67 years) were included. MRI established the diagnosis in all cases by differentiating active infection or epidural abscess from postoperative fibrosis or degenerative changes. Blood cultures identified methicillin-sensitive Staphylococcus aureus in one patient, while urinary and wound cultures yielded organisms in another patient without microbiological confirmation from the spinal infection site. One patient with stable neurological findings improved with antibiotic therapy and multidisciplinary supportive care, whereas two patients underwent surgical decompression, including one with staged hardware revision, in addition to systemic antibiotics. At discharge, two patients achieved assisted ambulation, while one remained non-ambulatory.Conclusion: Postoperative SD and EA require a high index of suspicion because symptoms may mimic expected postoperative complaints. Contrast-enhanced MRI remains the cornerstone of diagnosis. Early individualized treatment, including appropriate antimicrobial therapy, timely surgical decompression when indicated, and multidisciplinary management, may improve neurological and functional outcomes.