Low　back　pain　(LBP)　is　a　common　health　issue　worldwide　with　a　huge　economic　burden　on　healthcare　systems.　In　the　United　States　alone,　the　cost　is　estimated　to　be　$100　billion　each　year.　Intervertebral　disc　degeneration　is　considered　one　of　the　primary　causes　of　LBP.　Moreover,　the　critical　role　of　the　vertebral　endplates　in　disc　degeneration　and　LBP　is　becoming　apparent.　Endplate　abnormalities　are　closely　correlated　with　disc　degeneration　and　pain　in　the　lumbar　spine.　Imaging　modalities　such　as　plain　film　radiography,　computed　tomography,　and　fluoroscopy　are　helpful　but　not　very　effective　in　detecting　the　causes　behind　LBP.　Magnetic　resonance　imaging　(MRI)　can　be　used　to　acquire　high-quality　three-dimensional　images　of　the　lumbar　spine　without　using　ionizing　radiation.　Therefore,　it　is　increasingly　being　used　to　diagnose　spinal　disorders.　However,　according　to　the　American　College　of　Radiology,　current　referral　and　justification　guidelines　for　MRI　are　not　sufficiently　clear　to　guide　clinical　practice.　This　review　aimed　to　evaluate　the　role　of　MRI　in　diagnosing　LBP　by　considering　the　correlative　contributions　of　vertebral　endplates.　The　findings　of　the　review　indicate　that　MRI　allows　for　fine　evaluations　of　endplate　morphology,　endplate　defects,　diffusion　and　perfusion　properties　of　the　endplate,　and　Modic　changes.　Changes　in　these　characteristics　of　the　endplate　were　found　to　be　closely　correlated　with　disc　degeneration　and　LBP.　The　collective　evidence　from　the　literature　suggests　that　MRI　may　be　the　imaging　modality　of　choice　for　patients　suffering　from　LBP.　Level　of　Evidence　1　Technical　Efficacy　Stage　3