Degenerative alterations of the spine are among the most common causes of complaints of the musculoskeletal system. Imaging procedures are an established component of diagnostics and differential diagnoses. A reduction in height of the intervertebral space and sclerotization of the basal and covering plates are part of the first radiological alterations and in the further course can be accompanied by formation of spondylophytes, arthrosis of the intervertebral joints and degenerative vertebral surface gliding. However, early changes of the mobile segments can often not be visualized in x-ray images. Computed tomography (CT) and magnetic resonance imaging (MRI) substantially improve the diagnostic options. Using MRI the spinal column and the surrounding soft tissues can be visualized in 3-D and a differential diagnostic differentiation between inflammatory, traumatized or neoplastic processes is possible. A lack of correlation between the imaging findings and clinical symptoms remains problematic. A meaningful interpretation of x-ray images and MRI can only be made with the appropriate knowledge of the symptoms and possible diseases.