Forty patients with hematogenous pyogenic vertebral osteomyelitis have been considered. The clinical picture has been presented, emphasizing the often subtle and subacute nature of the disease. The laboratory findings in many patients demonstrated a high sedimentation rate with a normal or slightly elevated leukocyte count. Frequently, the lesion was not demonstrable by roentgenogram early in the disease. Eventual spontaneous interbody fusion was the rule. Optimum treatment should include an accurate bacterial diagnosis followed by therapy with the appropriate antibiotic, bedrest, and immobilization. Despite the long morbidity there is minimum residual disability. This study has emphasized the beneficial results obtained by immobilization in comparison with those following operative intervention.