Low back pain is a common clinical complaint, the vast majority of people with low back pain may first think of lumbar muscle strain, lumbar disc herniation. Here I will roughly list the causes of low back pain, according to the etiology is divided into the following categories: 1, trauma: including acute and chronic trauma caused by acute or chronic injury to the muscles of the low back, spinal vertebrae and accessories of the injury, fracture. For osteoporosis patients, very minor trauma or no obvious traumatic factors can lead to vertebral fractures and cause pain. Chronic injuries leading to muscle strain, chronic ligament injuries, interspinous ligament injuries, etc. can lead to low back pain; 2, degenerative spinal lesions: such as osteophytes, herniated discs, ligament hypertrophy, etc. can lead to spinal stenosis, nerve root compression and the symptoms of low back pain; vertebral body degeneration of the small joints, joint dysfunction, vertebral body slippage and so on can lead to low back pain; 3, spinal dysplasia: such as bony canal stenosis, lumbar sacralization, lumbar vertebrae and the spine, and so on can lead to low back pain. Spinal dysplasia: such as bony spinal stenosis, lumbar sacralization, unilateral hypertrophy of lumbar transverse processes and sacral/iliac joints, congenital non-connection of vertebral roots, spinal cryptorchidism, overgrowth of spinous processes, scoliosis, vertebral developmental deformities such as half-vertebral body, butterfly vertebrae, etc.; 4, immune diseases or systemic diseases: such as ankylosing spondylitis, sclerosing sacroiliac arthritis, etc.; 5, spinal tumors or tumor-like lesions: such as vertebral body hemangiomas, myeloma, aneurysmal bone cysts, metastatic tumors, giant tumors, and so on. metastatic tumor, giant cell tumor, eosinophilic granuloma, etc.; 6, intravertebral canal lesions: extraspinal tumors such as neurofibromas, nerve sheath tumors, spinal meningiomas, epidermoid cysts, vascular malformations, etc.; 7, vertebral infectious lesions: such as vertebral tuberculosis, vertebral inflammation, inflammation of intervertebral discs, etc.; 8, retroperitoneal lesions: such as retroperitoneal tumors, enlarged lymph nodes or metastasis of tumors, pancreatic cancer, cholecystitis, or gallbladder stones, Complications of duodenal ulcer, colon tumor, renal cancer or ureteral stone, infection, etc.; 9, reproductive system lesions: gynecological, such as pelvic inflammatory disease, adnexitis, pelvic stasis, uterine tilt, uterine fibroids, etc.; men’s prostatitis, adenitis of seminal vesicles, etc.; 10, endocrine system disorders: osteoporosis, hyperparathyroidism, etc.; 11, toxicity disorders: fluorine bone disease, etc.. As there are too many diseases that can cause low back pain, clinicians need to exclude lesions one by one according to the patient’s complaints, age, occupational characteristics, time of onset, clinical manifestations and physical examination, laboratory tests, imaging tests. The above diseases are only common diseases that need to be ruled out in the clinic, and there are some rare diseases that involve orthopedics, rheumatology, gynecology, urology, oncology, endocrinology, traditional Chinese medicine, surgery or rehabilitation, interventional therapy, etc., which shows that the diseases are not as simple as we think. I have consulted many patients with low back pain, which have been treated as lumbar disc herniation, and later on, they were respectively identified as vertebral tumors, intravertebral tumors, intravertebral vascular malformations, vertebral tuberculosis by magnetic resonance examination, and some of them were retroperitoneal tumors. Therefore, when the common single symptom of low back pain is present, multiple tests may be needed to determine the cause. And patients need to understand why doctors will give themselves a bunch of checklists, because the learning behind this simple low back pain is really too big!