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This historical perspective traces the history of the development of pathoanatomically based spinal disease diagnosis and the subsequent use of these diagnoses for scientific and social purposes. Spinal diagnostic categories have been used positively to guide both clinical (including their use as the primary units of investigation in many epidemiological and evidence-based projects) and basic science (studying the pathoanatomic disease outside of the patient) research programs—the aim being the improvement of patient care and outcomes. They are also used socially to confer/reject acceptability to patient behavior; to justify health policy decisions; to structure medical relationships; to shape medical/institutional infrastructure; to direct patient care via guideline establishment; and to manage health care. The positive and negative implications of the use of spinal disease categories are discussed.