Prevalence and Cost

The prevalence of FBSS should be placed in the context of low back pain in general (Anderson et al., 1999; Bressler et al., 1999). The economic environment and local beliefs have an important influence on the type of treatment offered to low back pain patients. Comparing rates of back surgery in eleven countries, Cherkin and al demonstrated an almost linear increase in spinal surgery with the per capita number of orthopaedic and neurosurgeons in the country (Cherkin et al., 1994). However, the adequate ratio neurosurgeon-orthopaedic surgeons/population needed per capita has not been defined and most probably cannot be determined.

The United States National Council on Compensation Insurance in Healthcare estimates the costs of work-related low back pain 8.8 billion US$, not taking into account lost work, lost tax revenue, and indemnity (Williams, 1998). Most costly are diagnostic procedures (25%), surgery (21%), and physical therapy (20%). The past 20 years have witnessed significant changes in the indications for, and use of, instrumentation in lumbar spine surgery. Between 1979 and 1990 there has been an increase of over 55% in the incidence of spine surgery for chronic low back pain (Gibson et al., 1999).

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