Successful Management of Lumbosacral Spondylodiscitis Using All-Posterior Four-Rod Spinopelvic Fixation Without Anterior Reconstruction: A Case Report and Literature Review.

Spondylodiscitis of the lumbosacral spine is uncommon and presents unique diagnostic and therapeutic challenges. The compromised stability of this junction due to infection often necessitates surgical intervention. Anterior column reconstruction usually becomes necessary given the inherent shear force at this junctional area. Our case represents a unique management strategy without anterior column reconstruction; three-column stability was achieved by modifying fixation with a four-rod technique instead of the standard two rods. We report a 49-year-old female with insidious-onset low back pain, bilateral leg tingling, and constitutional symptoms. Imaging revealed destruction from L4 to S1 with sacral ala involvement and right sacroiliac joint changes, consistent with tuberculous spondylodiscitis. Laboratory markers were elevated, and the Tuberculosis Spine Instability Score (TSIS) was 12. The patient was empirically started on anti-tubercular therapy (ATT) and underwent an all-posterior approach with decompression, debridement, and lumbo-pelvic fixation using a four-rod construct. Postoperatively, she was mobilized early, discharged on day 7, and continued 18 months of ATT. At two-year follow-up, she showed solid fusion and an intact construct. She marked functional recovery, with the Oswestry Disability Index improving from 90% to 10% and the Visual Analog Scale score from 9/10 to 0. Posterior-only lumbo-pelvic fixation with a four-rod construct provides a safe and effective solution for extensive lumbosacral tuberculous spondylodiscitis with sacral extension. In endemic regions, empirical ATT based on clinicoradiological suspicion is justified even when microbiological confirmation is lacking.