The principles of management of PVO are similar to other musculoskeletal infection and includes establishment of bacteriological diagnosis, debridement and stabilization. Majority of PVO may be treated with nonoperative treatment with rest for control of pain and muscle spasm, and administering appropriate antibiotic through parenteral route for adequate duration. Indications for surgery may include failure to control infection, abscess formation, neurological deficit and spinal instability secondary to bony destruction. Unlike infection in cortical bone, use of implants may not lead to persistence or recurrence of infection and instead may help to curb infection with stability. However, use of hardware in the presence of active infection is not without concern. The relative safety of use of implant is based on the retrospective studies of small case series. Evidence-based support in favor of safety and efficacy of instrumentation may require prospective, double-blinded, randomized, controlled study and possibly multicenter cooperation and animal experiments.