Spinal diseases belong to the most frequently occurring disease groups. Accordingly diagnostic spinal imaging is probably the most common imaging procedure after chest X-ray. Since more than 30 years plain X-ray films are unchanged the first standard procedures. Discrepancies in size and localization of pain and the X-ray results are very often, because pain is in many cases soft-tissue dependent, abnormalities on X-rays images mostly bonybased, however. Therefore in many cases additional examinations like "functional" and oblique views are necessary. Of great help are also CT and MRI. With both modalities soft tissues abnormalities are very well demonstrated. For a lot of questions both modalities are already the "gold standard" of imaging. However, bone scintigraphy is the method of choice in screening of bone metastasis and follow up of inflammatory and malignant abnormalities.