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Q: back pain ( Answered,   0 Comments )
Subject: back pain
Category: Health > Conditions and Diseases
Asked by: ralfborchert-ga
List Price: $200.00
Posted: 19 Dec 2005 12:49 PST
Expires: 18 Jan 2006 12:49 PST
Question ID: 607588
Estimate the number of surgeries being done to alleviate back in the developed world

Clarification of Question by ralfborchert-ga on 19 Dec 2005 14:50 PST
You may replace estimate with "give an overview" or "paint a word-picture", thanks
Subject: Re: back pain
Answered By: welte-ga on 21 Dec 2005 16:12 PST
Hi ralfborchert-ga, and thanks for your questions.

As you likely know, back pain is a major problem worldwide.  The World
Health Organization recently published a study looking at a large
number of musculoskeletal disorders on an international scale.  You
can find the report here:

Woolf AD & Pfleger B.  Burden of major musculoskeletal conditions.
Special Theme - Bonoe and Joint Decade 2000-2010. Bulletin of the
World Health Organization 2003; 81:646-656.

On page 652 of the above document, the authors describe low back pain.
 As suggested by another Researcher, there is some difficulty in
describing this disorder on an international scale due to differences
in definitions:

"Back pain is very common, but its prevalence varies according to the
definitions used and the population studied. A large study from the
Netherlands reported an incidence of 28.0 episodes per 1000 persons
per year and for low back pain with sciatica an incidence of 11.6 per
1000 persons per year. Low back pain affects men a little more than
women and is most frequent in the working population, with the highest
incidence seen in those aged 25?64 years (58). New episodes are twice
as common in people with a history of low back pain. Lifetime
prevalence is 58?84% and the point prevalence (proportion of
population studied that are suffering back pain at a particular point
time) is 4?33%."

A second article authored by Dr. Woolf (with Dr. Mody) describes how
often surgeries are performed for lower back pain in major
industrialized countries:

"The annual rate of operations for herniated lumbar disc operations
per 100,000 population is 10 in the UK, 20 in Sweden, 35 in Finland
and over 100 in the US.[22]"

Mody GM & Woolf AD.  The Global Burden of Musculoskeletal Disorders. 
Business Briefing: Global Healthcare 2003.

The data cited above comes from the following article (Ref. 22 in the
above article):

[22]  G B J Andersson, ?Epidemiology of Low Back Pain?, Acta Ortho.
Scand., 69 (1998)Suppl. 281, pp. 28?31.


Another important article is the following:

Andersson GB.  Epidemiological features of chronic low-back pain. 
Lancet. 1999 Aug 14;354(9178):581-5. Review.

This last article is, unfortunately, not freely available online,
however you can request a reprint from the author:

I will provide some relevant excerpts.  

"Volinn and colleagues[45] examined the US National Hospital Discharge
Survey for time trends (1979-87), and Taylor and colleagues[3]
extended the study to include data up through 1990. During the 11
years surveyed, operations among adults for low-back pain increased by
55% from 147 500 in 1979 to 279 000 in 1990. This rise corresponds to
an increase from 102 to 158 per 100 000 adults. This increase was
particularly great for fusions that increased by 100% from 13 to 26
per 100 000 adults. In 1990, there were 46 500 lumbar fusions and 232
500 operations without fusion for low-back pain. Non-surgical
admissions to hospital, on the other hand, decreased from 402 per 100
000 adults in 1979 to 150 per 100 000 adults in 1990. The average rate
of back surgery for 1988-90 were lowest in the west (113 per 100 000
adults) and highest in the south (171 per 100 000 adults). Similar
regional trends were also found for non-surgical hospital admissions.

There are substantial variations between countries in rates of back
surgery. Cherkin and colleagues[46] compared the rates of surgery for
back pain in 13 countries and Canadian provinces and found that in the
USA, the rate is at least 40% higher than in any other country, and
more than five times higher than in Scotland and England (figure 2).
Differences in the underlying prevalence of back pain are unlikely
explanations for the differences in surgical rates. More likely
explanations are cultural differences, differences in practice
patterns, and the availability of health-care providers."

Figure 2 from this article gives a comparison, based on data from
Cherkin, et al., comparing the frequency of surgery for back pain in
11 countries and Canadian provinces relative to the USA.  You can
download this figure here:

This is a higher resolution image, but no caption:

Here is a version including the caption:

Source of original data:
Cherkin DC, Deyo RA, Loeser JD, Bush T, Waddell G. An international
comparison of back surgery rates. Spine 1994; 19: 1201-06.

Another article by David Borenstein in Washington, DC reviews low back
pain, giving an excellent overview of the problem, including a
breakdown of costs:

Borenstein DG. Epidemiology, etiology, diagnostic evaluation, and
treatment of low back pain. Current Opinion in Rheumatology 2000,


Other resources:

eMedicine articles on back pain, including epidemiological data:

McGlynn EA & Clark KA. Low Back Pain (Acute).

You may also find this article useful:

Lavis JN, Malter A, Anderson GM, Taylor VM, Deyo RA, Bombardier C,
Axcell T, Kreuter W.  Trends in hospital use for mechanical neck and
back problems in Ontario and the United States: discretionary care in
different health care systems.  CMAJ. 1998 Jan 13;158(1):29-36.

The full text is freely available from the link above.


I hope this information is useful.  Please feel free to request
clarification prior to rating.

There are no comments at this time.

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