Surgical management of low back pain

Atkinson and Zacest1 stated that chronic low back pain is reaching epidemic proportions for a variety of medical, psychosocial and work-related problems. The direct and indirect economic cost in Australia has been modelled at $9.17 billion.2 The provision of surgery for non-specific low back pain (NSLBP) has the potential to significantly increase these costs, particularly under the economic cloak of “work cover”. A review of chronic low back pain pointed out that only 15% of cases may be due to significant intervertebral disc prolapse with neural compromise.3 The remaining cases were placed under the umbrella of NSLBP, which is a negative description of the failure to reach a diagnosis.