Back or neck pain needs context, not only an image.

Pain in the lower back without one identifiable structural cause or serious underlying disease. It is the most common low-back presentation and may be influenced by load, movement, sleep, stress and physical capacity.

• Local low-back pain, sometimes extending into the buttock or thigh
• Stiffness or limitation with bending, lifting or prolonged positions
• Symptoms that change with position and activity

Disc material extends beyond its usual boundary and may irritate or compress a nerve root. Bulges and herniations also occur in people without pain, so imaging findings must match the symptoms and examination.

• Pain travelling from the back or buttock into one leg
• Numbness, pins and needles or burning in a nerve distribution
• Possible muscle weakness or reflex change
• Pain that may increase with coughing, sneezing or certain positions

Narrowing of the spinal canal or nerve passageways, usually related to age-associated changes. Not every stenosis visible on imaging produces symptoms.

• Pain, heaviness, numbness or weakness in one or both legs when walking or standing
• Symptoms often eased by sitting or bending forward
• Reduced walking distance and frequent need to rest

Spondylolysis is a stress defect or fracture in part of a vertebra; spondylolisthesis is the slipping of one vertebra relative to another. Either may be asymptomatic or cause pain and, less often, nerve irritation.

• Low-back pain that may increase with standing, walking or extension
• Stiffness and hamstring tightness
• Buttock or thigh pain
• Leg pain, tingling or numbness when a nerve root is involved

A fracture of the vertebral body, commonly after trauma or in weakened bone such as osteoporosis. It requires medical assessment and should not be treated as routine low-back pain.

• Sudden severe back pain, sometimes after a fall or minor load
• Pain worse when standing or moving
• Local tenderness over the vertebra
• Progressive height loss or increasing kyphosis with multiple fractures

Neck pain without one specific pathology or serious identifiable cause. It commonly reflects a combination of load, sustained positions, movement and tissue tolerance.

• Pain and stiffness in the neck or shoulders
• Limited head turning or bending
• Pain extending into the upper back or shoulder
• Position- or movement-related headache in some people

Age-associated changes in the discs, vertebrae and joints of the neck. These are common without symptoms, so clinical relevance depends on matching the findings with the complaint and examination.

• Intermittent neck and shoulder pain or stiffness
• Reduced neck movement
• Headache often starting at the back of the neck
• Crepitus with movement, which alone does not necessarily indicate injury

Disc material or degenerative change may irritate a nerve root in the neck. Symptoms typically travel into the arm and hand in a pattern related to the affected nerve.

• Pain from the neck into the shoulder, arm or hand
• Numbness or tingling in the arm, hand or fingers
• Weakness in selected arm or hand muscles
• Symptoms that change with neck position or movement

A neck injury caused by rapid acceleration–deceleration, most commonly during a motor-vehicle collision. It may involve pain, movement restriction and other symptoms after trauma.

• Neck pain and stiffness appearing immediately or after several hours
• Headache, often from the base of the skull
• Shoulder or upper-back pain
• Dizziness, fatigue or concentration difficulty in some people

Headache referred from structures in the neck. Location alone does not establish the diagnosis and migraine and other headache types must be considered.

• Pain beginning in the neck or skull base and spreading into the head
• Often more prominent on one side
• Restricted neck movement
• Aggravation with selected neck positions or movements

Compression of the spinal cord in the neck, usually from stenosis or degenerative change. It is a neurological condition requiring prompt medical assessment.

• Loss of hand dexterity, difficulty with buttons, writing or grip
• Balance disturbance, unsteady walking or heavy legs
• Weakness, numbness or tingling in the arms and/or legs
• Bladder or bowel control changes in advanced cases

An inflammatory rheumatological disease mainly affecting the sacroiliac joints and spine. Clinical suspicion requires medical and, where indicated, rheumatology assessment.

• Back pain usually starting before age 45 and lasting more than three months
• Morning stiffness and night pain
• Improvement with movement rather than prolonged rest
• Alternating buttock pain; possible associated eye inflammation, psoriasis or inflammatory bowel disease