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The unsustainable rise of health care costs in the US, coupled with suboptimal health outcomes, is driving both conversation and real action toward value-based care (VBC) models in this country. There is no more low-hanging fruit for this effort than spine-related disorders. Low back and neck pain cost us more than $134 billion annually and continues to rise at a rate more than twice that of overall health spending despite the fact that it is already at or near the top of all direct health care expenditures.
Despite aggressive and often invasive treatment approaches, low back pain remains the leading cause of physical disability worldwide with neck pain not far behind. This divergence between cost and outcomes is driven largely by the sustained use of expensive and ineffective treatments that can lead to more harm than benefit. Overreliance on prescription opioids began in the early 2000s, based on weak evidence suggesting that these medications were safe and effective treatments. In addition, the US maintains a higher rate of surgical interventions, more frequent specialist consultations for initial diagnoses, and consistently higher use of medically unnecessary advanced imaging when compared to international standards.
Recognizing the profound impact of spine-related disorders, organizations including the American College of Physicians, the Centers for Disease Control and Prevention, the Department of Veterans Affairs, and the World Health Organization have all advocated for evidence-based, nonpharmacological treatment strategies for low back pain. These approaches emphasize conservative care as the first line of treatment, with invasive interventions reserved for cases in which patients do not improve with initial measures. However, adherence to guidelines remains poor, reflecting a systemic misalignment of incentives and care priorities in spine care.