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Background: Andersson lesion (AL), also known as aseptic spondylodiscitis, is a pathological condition characterized by a destructive lesion in the vertebral or discovertebral region. The aim of this study was to assess functional, radiological, and neurological outcome of midline posterior surgery with transfacetal/transpedicular decompression and long-segment instrumentation and fusion in all patients with AL. Materials and Methods: A total of 36 consecutive patients with AL with or without neurodeficit were managed with midline posterior approach with long-segment fixation, decompression and anterior vertebral reconstruction added by same midline approach. The demographic data, visual analogue scale (VAS), modified Oswestry Disability Index (mODI), ankylosing spondylitis quality of life (ASQoL), local and global kyphosis angle, Frankel neurological grade, blood loss, duration of surgery, perioperative complications, and fusion rate were compiled and assessed. Results: The mean age of the patients was 52 years (26 males and 10 females). Among the patients, 9 patients had thoracic, 25 patients had thoracolumbar, and 2 patients had lumbar vertebral involvement. All patients in the study achieved fusion at final follow-up period of 24 months. The mean duration of hospital stay, intraoperative blood loss, and surgery duration was 6.17 days, 252 mL, and 130 min, respectively. VAS improved from mean 7.69 ± 0.98 to 1.67 ± 0.72, mODI from mean 70.28 ± 3.55 to 21.14 ± 2.13, ASQoL from mean 14.22 ± 1.59 to 7.17 ± 1.25, local kyphosis from 23.61 ± 1.67 to 18.52 ± 1.05, and global kyphosis from 57.02 ± 0.72 to 36.16 ± 1.23, leading to better sagittal balance. Except two patients all had full neurological recovery. Conclusions: Posterior midline approach with long-segment instrumentation and anterior decompression by transpedicular/transfacetal approach and bone grafting with selective use of cages can give satisfactory results with excellent fusion rates and good functional outcomes.