The presentation of a patient with primary spine pathology may be confounded by a myriad of symptoms that span many organ systems. Likewise, imaging findings are often diverse and may be as subtle as slight posterior joint asymmetry combined with paravertebral myofascial strain or as goss as fracture-dislocation with neurological sequelae. A systematic approach to selecting and applying the appropriate imaging study combined with a careful clinical history and examination will insure a more accurate diagnosis and proper treatment. The biomechanics of injury and the pathophysiology of the disease process in question should always be considered. This review discussed an algorithmic approach for understanding spine imaging with discussions of radiography, radionuclide scan, myelography, computed tomography scanning and magnetic resonance imaging.