One of the aims is to understand the role of X-ray in pain medicine. Despite of the 6 weeks conservative management in the absence of trauma, when the back pain persists, X-ray is indicated. Radiological anatomy of the spine illustrates about cervical spine, thoracic spine, lumbar spine, and sacroiliac joints. Spine x-ray can be interpreted by alignment, bone morphology, cartilage, disk height, end-plate of the vertebral body, facet joints, and soft tissues and structures around. Radiological evaluation would be incomplete if sacroiliac joints are not assessed.