Pyogenic spinal sepsis in adults. Twenty adult patients presented with bacteriologically and histologically proven nontuberculous spinal sepsis. Thirteen patients presented with varying degrees of neurologic impairment. All patients underwent spinal decompression; in 11 this was combined with an anterior fusion using autogenous tricortical iliac grafts. All patients have recovered and are ambulatory, and no patient's disorder was made worse by surgery. Twenty-three separate organisms were cultured, only five of which were Staphylococcus. The antibiotic courses were shorter and pain relief more rapid with anterior fusion. All anterior bone grafts incorporated rapidly, and there was no progression of kyphosis or sequestration of grafts, regardless of organisms or level. The rational treatment of adult spinal sepsis necessitates the securing of tissue from the spine for histologic and bacteriologic examination. Pain relief, stabilization, and neural decompression can best be achieved with anterior decompression and fusion. Autogenous iliac crest grafts incorporate in the presence of sepsis. 