Spinal fusion surgery for lumbar non-specific low back pain is controversial, particularly because the origin of the pain is undetermined and imaging of the spine is unhelpful. The procedure dates back to 1889 but it is in the past 20 years that there has been a great escalation internationally in its use, with an increase of 267% over 11 years in the United States alone. There has also been a disproportionate increase in the rate of spinal fusions in private hospitals compared with public hospitals, with a 10.8 fold increase in private hospitals.
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