This document discusses the approach to low backache. It covers the anatomy, history taking including onset and characteristics of pain, various causes including congenital, traumatic, inflammatory, degenerative and metabolic factors. It also discusses the physical examination, investigations like CT, MRI and bone scans, differential diagnosis, conservative treatment options and indications for surgery. Surgical treatments including open and minimally invasive techniques are outlined as well as potential complications, prevention of backache and failed back syndrome.