Purpose: Back pain is a significant problem in USA and Europe with important socio-economic impact. The purpose of this study was to evaluate the incidence of spinal surgery for patients with back pain.

Study design: This was a retrospective Level II type study. Patient sample included five thousand one hundred and forty five patients with a five year follow up.

Methods and results: During past five years 5145 patients were seen in the back pain screening clinic. 823 patients (16%) were referred to the spine clinic (p<0.001). 127 patients (2.47%) were operated on (p<0.001). 106 patients (2.1%) had lumbar discectomy/decompression, 9 (0.59%) cervical discectomy, 3 (0.06%) pars reconstruction, 9 (0.17%) fusion and PLIF for spondylolisthesis, 5 (0.1%) decompression for spinal stenosis and 1 (0.01%) subtraction osteotomy for kyphosis. 5 patients (0.1%) were referred with “red flag” symptoms: 4 with spinal stenosis and 1 with tumour. 17 patients (0.3%) had discogram. 4 of them went for surgery: 1 had L4/5 PLIF, 2 L5/S1PLIF and 1 L5/S1 discectomy. 289 patients (5.6%) had nerve root blockade. Following NRB 47 patients (0.9%) had discectomy/decompression (p<0.001). 62 patients had discectomy/decompression without previous NRB. L5/S1 discectomy was the most common (48 pts; 0.9%). 86 patients (1.7%) had facet joint injections. 8 patients (0.15%) had surgery following FJI (p<0.001). 1 patient had L4 nerve root decompression, 3 L4/5 discectomy, 1 L5/S1 nerve rot decompression, 1 alartransverse fusion and 1 L5/S1 PLIF. 465 patients (9%) did not have nerve root blocks or facet joint injections. 3 patients (0.06%) had epidural injections of local anaesthetic and steroid.

Conclusion: Spinal surgery is not commonly performed in patients with back pain. Majority of patients can be treated conservatively. Prior to surgery nerve root blocks and facet joint injections are useful in selected patients.