Chronic back pain in aged subpopulation is relatively common and comprise of various pain syndromes originating from vertebral bodies, joints, muscles, and other soft tissues. Although the causes of chronic low back pain in elderly patients may differ patient to patient, common presentations seen in clinical settting are disorders related to inervertebral disc, spinalstenosis, compression fracture related to osteoporosis, and pain originating from zygapophysial joints and other surrounding atructures. Less common but other important causes in such group include metastatic lesions, infection, and myofacical pain syndromes, Here, evidence-based loterature review on common disorders affecting elderly patients causing chronic low back pain is presenter with special attention focused on diagnostic and therapeutic approaches based on pathophsiologic processes and clinical presentations. Every effort should be made to contemplate all possible factors that might have played roles in generating the chronic pain in these patients. Also, whichever management chosen it should have been decided based upon the clinical presentaions that are closely correlated with definitive findings from studies best avaialbe whenever possible. However, it should be born in mind that structural abnormalities seen in imaging study are not always the major causative factors responsible for clinical symptoms and signs. Recent studies have indicated the importance of biochemical or neruohumoral factors for generation of persistent neurological symptoms and signs that may account the dominant component of clinical findings. Thus, minimal invasive treatments based on these findings, should be first considered before any invasive or surgical interventions.