Three cases of vertebral osteomyelitis in intravenous drug abusers are described, and 64 cases in the literature are reviewed. The patients were almost exclusively heroin users from the United States, were predominantly male, and were frequently of black or Hispanic ethnic background. Symptoms were present for less than threemonths in 81% of patients. On admission to the hospital, fever was seen in 42%, transient neurologic deficits in 15%, elevated erythrocyte sedimentation rate in 91%, and leukocytosis in 35%. Twenty-two percent of patients with initially normal X rays had spinal abnormalities detected by tomography and technetium bone scan. A strikingly high incidence (27%) of cervical spine involvement was found. Gram-negative aerobic bacilli accounted for 82% of infections, and Pseudomonas species comprised 66% of the total. Ninety-two percent of the patients responded to parenteral antibiotic therapy administered for four weeks or longer. Patients experiencing relapses responded to a second course of therapy. The prognosis for intravenous drug abusers with vertebral osteomyelitis appeared to be good with appropriate therapy, and no deaths or permanent neurologic sequelae were seen.