The diagnosis of pediatric vertebral osteomyelitis has been enhanced through the use of computed tomography scan and magnetic resonance imaging. A retrospective analysis of seven patients with vertebral osteomyelitis was done to determine the studies used in medical management decisions and the outcome of these studies. Computed tomography scans were valuable in predicting if a patient would respond to medical management. The presence of a phlegmon on the computer-assisted tomography scan uniformly resulted in a failure of medical management or an indication for primary surgical management.