Spinal and paraspinal infections caused by Streptococcus pneumoniae remain a rare event. We present two cases from our institution, discuss the pathophysiology, and present a literature review of an additional 50 cases of spinal pneumococcal infections. Spinal epidural abscess and vertebral osteomyelitis as well as paraspinal abscesses caused by pneumococcus were included in the analysis. As has been reported for spinal infections due to other bacteria, persistent localized back pain with an elevation in inflammatory markers was almost universal. The lumbar spine was the most commonly involved. Pneumococcus was most frequently isolated from material obtained at the site of the infection; blood cultures were a less common source. The majority of patients with neurologic deficits had spinal epidural abscess or phlegmon, and had a higher mortality. Most patients were treated with 6 weeks of parenteral antimicrobials, and surgical intervention was not associated with a mortality benefit.