The CT findings and their differential points were evaluated by reviewing the CT scans of 47 patients with destructive lesions of vertebral bodies which included tuberculous spondylitis (23), pyogenic infection(9), syphilitic spondylitis (1) and malignant lesions(14). Twenty-one (91.3%) of 23 patients with tuberculous spondylitis showed mixed osteolytic and osteosclerotic patterns of bony destruction. Six(66.7%) of 9 patients with pyogenic infection and 10(71.4%) of 14 malignant lesions showed osteolytic pattern of bony destruction. Thirty (90.9%) of 33 infectious lesions including pyogenic infection and tuberculous spondylitis involved intervertebral disc, while the involvement of intervertebral disc was not found in malignant lesions. The Swiss-cheese appearance of bony destruction was commonly seen in tuberculous spondylitis, but pyogenic infections and malignant lesions more commonly revealed geographic or moth-eaten appearance. The sequestral pattern and sclerotic rims in and around bony destruction were mainly seen in tuberculous spondylitis, and they were thought to be specific findings in tuberculous spondylitis. CT of the spine appears to offer the detailed the detailed findings of vertebral body destruction and may be a useful adjunct in differentiation between tuberculous spondylitis, pyogenic infections and malignant lesions of the spine.