In painful lesions of the spine, the diagnosis must be established by different radiological methods and, in addition, confirmed histologically by a biopsy. For this purpose, representative tissue samples can be obtained by needle biopsy. The cause of backache may be degenerative processes, systemic osteopathies, traumatic lesions, bone necroses, bone granulomas, metabolic disorders, inflammation, pathologic bone remodelling, or bone tumors. Using autopsy material, even macroscopic analysis is possible. Pathological-anatomical, and radiological findings are essential for the diagnosis and therapy of most lesions of the spine.