Low back pain is commonly reported by patients in primary care and will affect most adults at some time during their lifetime. The socioeconomic burden of low back pain is high. In the United States, the condition accounts for 2% of all physician office visits and is the fifth most common reason for primary care office visits.1 Between 1997 and 2005, medical expenditures for spine-related problems increased more rapidly than overall health expenditures.2 One treatment option for low back pain is injection therapy, which received attention in 2012 after the fungal meningitis outbreak caused by contaminated steroid injections.3 A recent study among privately insured populations in the United States revealed substantial practice variation in the use of injection therapy by practitioners.4 This study demonstrated that the average number of injection procedures per patient varied from 1 to 9 procedures per year between the lowest and highest decile of practitioners.4 To know whether high utilization rates of individual clinicians also reflect favorable clinical outcomes, procedure rates should be linked to the severity of the spinal pathology and patient-reported outcomes.
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