In a series of 24 patients with proved hematogenous, pyogenic vertebral osteomyelitis, the disease was insidious in onset in 20. Because X-ray findings were inconclusive, vertebral-body biopsy was required for an accurate diagnosis, when the blood culture was negative. Despite the frequent presence of abnormal roentgenographic shadows, drainage was required in only 2 patients. Exploration for abscess cannot be determined on the basis of roentgenographic finginds alone. The frequency of a benign course and failure of spontaneous athrodesis induced speculation concerning possible attenuation of the virulence of the organism, altered host immunity, or perhaps, with regard to spontaneous fusion, merely a modification of an end point of the pathologic process by antibiotic treatment.