Study Design. A case of pyogenic spondylitis in S1-S2 is presented. Objective. To describe the diagnosis and management of this rare spondylitis. Summary of Background Data. The segment including the first and second sacral vertebrae is not mobile. Therefore, discitis of S1-S2 and adjacent spondylitis is very rare. To the authors' knowledge, this is the first reported case of infectious spondylitis in an immobile segment: S1-S2. Methods. In addition to radiography and bone scintigraphy, magnetic resonance imaging was used to confirm the diagnosis. Changes consistent with infectious spondylitis were shown, including an epidural abscess. Results. The patient was treated with laparoscopic drainage and biopsy. Staphylococcus aureus was cultured, and adequate antibiotics were administered. Repeat magnetic resonance imaging at approximately 4 months demonstrated normal signal intensity and disappearance of the abscess. Conclusion. Findings from this study show that pyogenic spondylitis can occur in immobile S1-S2.