Over the years there has been a relative increase in the incidence of vertebral osteomyelitis making it an important burden on healthcare worldwide. According to epidemiological studies the most common risk factors seem to be advanced age, male gender, intravenous drug use, and secondary immunodeficiencies including diabetes mellitus. The clinical presentation is nonspecific, with patients presenting with back pain, fever, malaise, and as such high clinical suspicion is very important in making the current and timely diagnosis. The most important clinical decision is wether to treat the patient conservatively or surgically. This decision is guided by the clinical presentation of the patient and by the use of clinico-radiological guidelines.