Pyogenic vertebral osteomyelitis may follow any process which initiates bacteremia and should be considered in a differential diagnosis of back pain occurring in the convalescent phase of septicemia. The two cases discussed here, following abdominal stab wounds, illustrate the principles of diagnosis and management of this problem. Diagnosis is based on gradual onset of low back pain with spinal tenderness and paravertebral muscle spasms, without neurologic symptoms. Serial X-rays are helpful, as are technetium phosphate or gallium bone scans. Appropriate antibiotic plus immobilization are recommended.