Percutaneous endoscopic debridement and drainage (PEDD) has been reported to be an effective procedure in treating early infectious spondylodiscitis. However, it is not clear whether PEDD can be effective in treating cases of complicated infectious spondylitis with significant abscess formation or vertebral destruction. Two women and four men with poor general health and complicated pyogenic spondylitis who underwent PEDD were evaluated. The causative bacteria were identified by PEDD in five of six. All six patients presented with spinal pain. Five patients reported relief from back pain within one week of surgery and recovered uneventfully after full course, specific, antimicrobial therapy. C-reactive protein (CRP) values returned to normal ranges within two to 22 weeks in these patients. The follow-up magnetic resonance imaging studies revealed that the paraspinal abscesses or epidural abscesses were resolved. No surgery-related complications were noted during or after the PEDD procedure. In conclusion, PEDD was effective in treating complicated infectious spondylitis. We propose that PEDD is an effective alternative to extensive surgery for complicated infectious spondylitis, especially in patients with multiple comorbidities.