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Low back pain is a ubiquitous symptom. It is the second most common complaint when visiting a provider in the United States.[1] It accounted for 4.4% of emergency department visits from 2000 to 2016.[2] The lifetime prevalence of back pain is approximately 70% to 85%.[3] The causes of low back pain range from muscle spasms and disc protrusions to more severe entities such as discitis, osteomyelitis, and malignancy. Imaging provides varied details based on modality. The most common modalities include radiographs, computed tomography (CT), and magnetic resonance imaging (MRI). Ultrasound (US) and nuclear medicine imaging are occasionally choices. The American College of Radiology enlists appropriateness criteria for evaluating back pain. Patients with uncomplicated back pain do not require imaging unless it persists for more than 6 weeks. However, patients with cauda equina syndrome, malignancy, suspected infection, or fracture require further imaging.[4] Symptoms of cauda equina syndrome would include saddle anesthesia and bowel or bladder incontinence. Patients presenting with fever and low back pain or patients with a history of drug misuse or immunosuppression should lead to suspicion of an infection. While plain radiographs are usually the first imaging modality, depending on the acuity, medical condition, and general contraindications to imaging modalities, the appropriate modality merits consideration. As a broad rule, whenever there is a concern for infection, or there is a suspicion of malignancy, contrast-enhanced studies are the recommended approach. ACR appropriateness criteria help in choosing the right modality in a variety of circumstances. CT is the imaging modality of choice in patients with suspected fractures. MRI is the modality of choice for patients who are possible candidates for augmentation procedures. MRI is also highly sensitive for evaluating tumors and metastasis. It is also the modality of choice for assessing cord compression.