For several years, interest in clinical practice patterns has increased due to concerns about the costs and quality of health care.

Our objectives were to examine recent trends and geographic variations in low back pain hospitalization.

We analyzed data from a Washington State automated database for 1987-1992.

Low back surgery rates in Washington changed little during the study years.

In contrast, nonsurgical hospitalization rates fell from 1 5.5 to 5.1 per 10,000.

The proportion of operations involving fusion decreased from 15.8% in 1987 to 11.7% in 1990, and then remained stable.

During 1990, important county-to-county variations were observed in surgery rates, nonsurgical hospitalization rates, the proportion of operations involving fusion, and the percentage of surgical patients undergoing reoperation within 3 years.

Wide county variations suggest that there may be overutilization or underutilization of low back pain treatments in some geographic areas.

A more consistent approach to the management of back problems may benefit patients.