Historically, pyogenic vertebral osteomyelitis was disease with high morbidity and mortality rate. In recent years, with advance of new diagnostic techniques, antimicrobial chemotherapy, and improvement in surgical techniques, the prognosis has improved dramatically. However, as a recent tendency, the number of patients tends to increase by aging of the patient, increase of immuno-compromised host and resistant bacteria. There is a case the spine infection with immuno-compromised host sometimes accompanies sepsis and to die. Therefore, the management of this disease has still many pitfalls and problems. An early diagnosis is necessary, and identification of causative organism and appropriate antimicrobial chemotherapy are basics of treatment. But when indicated, we should cooperate with a spinal surgeon closely, and choose surgical intervention.