The basic premise of this article is that low back disorders are extremely prevalent in all societies, and probably have not increased substantially over the past two decades. What has increased is the rate of disability, the reasons for which are uncertain. Not only has this phenomenon heightened the awareness of low back pain, but it has led to an explosion in costs. Although a precise estimate is impossible, it is plausible that the direct medical and indirect costs of these conditions are in the range of more than $50 billion per annum, and could be as high as $100 billion at the extreme. Of these costs, 75% or more can be attributed to the 5% of people who become disabled temporarily or permanently from back pain--a phenomenon that seems more rooted in psychosocial rather than disease determinants. Within this overall equation, spinal surgery plays a relatively small role, although the contribution to disability probably has more than passing significance. The future challenge, if costs are to be controlled, appears to lie squarely with prevention and optimum management of disability, rather than perpetrating a myth that low back pain is a serious health disorder.