A retrospective review of the cases of sixty-one patients with vertebral osteomyelitis revealed that the associated diseases of diabetes mellitus and rheumatoid arthritis as well as increased age and a more cephalad level of infection predisposed to paralysis. For patients with paralysis and a long-term follow-up, the prognosis for isolated nerve-root deficits is good with or without surgery. For patients with spinal cord compression, the results generally are better with anterior decompression and stabilization than with laminectomy. Early treatment should be directed at prevention of intrinsic spinal-cord damage, which is irreversible.