A study of a series of 82 cases of pyogenic osteomyelitis of the spine has shown that the clinical features at the initial stage of the disease often present such a varied picture that the correct diagnosis may easily be overlooked for a long time. Once radiographic changes are demonstrated, the primary consideration in differential diagnosis is tuberculous spondylitis. Bacteriological verification by needle biopsy or surgical exploration is recommended in order to institute an adequate antibiotic therapy. Surgical evacuation is advocated in cases with extensive vertebral destruction. The majority of patients recovered within 1 year from the onset of illness. In slightly more than half of the cases the spinal lesions healed with spontaneous interbody fusion. This tendency was most pronounced in cases of cervical and upper thoracic involvement. No deaths occurred as a result of the spinal disease.