Disorders of the neck and back

Abstract

Low back pain (LBP) is a heterogeneous condition with high prevalence, high morbidity, and large economic burden. According to the 2010 Global Burden of Disease Study, low back pain ranked highest among 291 studied disorders in terms of years lived with disability (YLDs), with a global point prevalence estimated to be 9.4 % (95 % CI 9.0-9.8). In 2005, direct expenditures for spine problems in the United States were estimated at $85.9 billion, which represented 9 % of the total national healthcare expenditures, similar to costs associated with arthritis, cancer, and diabetes, and only exceeded significantly by those for heart disease and stroke. In the United States between 2004 and 2008, it is estimated that over two million episodes of back pain resulting in presentation for emergency care occurred, yielding an incidence rate of 1.39/1,000 person-years. In workers 40-65 years of age, back pain costs employers an estimated $7.4 billion/year in lost productive time. Commonly, disorders of the neck and back are self-limiting conditions, which require only judicial use of imaging and rarely more invasive treatments. Many national and international groups have produced high-quality, evidence-based recommendations to aid in the diagnosis and treatment of low back pain (Table 1).