The communication between radiologists and their surgical colleagues is particularly important in the setting of back pain. This common disorder often does not have a definable cause, even when the imaging findings are abnormal. A shared understanding of the various causes of back pain, the appropriate terminology, and the needs of the surgeon is vital to proper patient treatment. Unfortunately, little standardization in the terminology for and management of back pain syndromes exists. This article elucidates the approaches to problems of back pain used in one clinical setting.