Study design: This study describes recent United States trends and regional variations in the management of low back pain.

Objectives: The authors investigated recent temporal trends and compared practices in different geographic regions.

Summary of background data: Controversy exists concerning the appropriate medical and surgical management of patients with low back pain.

Methods: National Hospital Discharge Survey data from 1979 through 1990 were analyzed. Case selection was based on previously developed algorithms intended to exclude nonmechanical causes of back pain.

Results: Over the period of study, nonsurgical hospitalizations for low back pain decreased dramatically. In contrast, low back operation rates, particularly for fusion surgery, increased substantially. In recent years, surgery and hospitalization rates were highest in the South and lowest in the West.

Conclusions: Rapidly increasing surgical rates and wide geographic variations suggest the need for a more consistent approach to back problems.