Twenty-two patients with severe back pain associated with radiologic evidence of vertebral sclerosis are reported. There were 19 women and 3 men; the average age was 42 years. Duration of pain averaged 4.3 years. The characteristic radiologic findings were diffuse sclerosis of the anterior inferior portion of the vertebral body and narrowing of the adjacent disc space. There was no extension of the sclerosis beyond the vertebral body, no paravertebral mass, and no loss of vertebral height. These radiologic characteristics, in conjunction with other clinical findings, should permit a diagnosis without the need for biopsy.