The first step is plain films. Many disease processes can be tentatively diagnosed with regular x-rays. Many evaluations end here with the discovery of significant degenerative change but no radicular symptoms. Please note that MRI and CT also require plain films for correlation. MRI or CT should be reserved for significant neurological symptoms or for persistent symptoms that do not respond to conservative therapy. Most patients with lower back pain improve spontaneously. When deciding whether or not to employ advanced imaging applications please consider whether or not the patient is a potential surgical candidate. If subsequent surgical intervention is not feasible there may be no need to proceed with further imaging evaluation. If further evaluation is clinically warranted, MRI without contrast is the examination of choice for disc disease. If evaluation of post surgical disc disease or scar is required, MRI of the lumbar spine with and without IV contrast is indicated. Other indications for MRI with and without IV contrast include tumor & metastatic disease.