Abstract:Pyogenic vertebral osteomyelitis is a diagnosis all physicians must be prepared to promptly recognize and treat. The mail predisposing factors include diabetes mellitus, intravenous drug use, and immunosuppression. The majority of infections occur via hematogenous spread to the vertebral body, with the lumbar spine being the most commonly involved region.Staphylococcus aureusremains the most common organism. Patients typically present with a progressive history of back or neck pain. The diagnosis if further suggested by elevations in the erythrocyte sedimentation rate, C-reactive protein, and appropriate findings on magnetic resonance imaging. The diagnosis is confirmed with biopsy and culture. Medical management is the main stay of treatment, but surgery continues to play an active role. Indications for surgical intervention include diagnostic uncertainty, the need for neural decompression, failure of antibiotic treatment, and instability. When pyogenic vertebral osteomyelitis is promptly identified and appropriately managed, the prognosis is generally favorable. The authors review the epidemiology, pathophysiology, clinical presentation, diagnostic tools, and therapeutic management of pyogenic vertebral osteomyelitis.