Global, Regional, and National Burden of Spinal Pain, 1990-2021, with Projection to 2035: A Population-Based Study

Spinal pain (SP), including low back pain (LBP) and neck pain (NP), remains one of the leading causes of disability worldwide, imposing substantial health and socioeconomic burdens. However, updated evaluations of long-term trends, cross-country inequalities, and future projections remain limited.

Using data from the Global Burden of Disease Study 2021, we assessed the global, regional, and national burden of SP across 204 countries and territories from 1990 to 2021. We analyzed prevalence, incidence, and disability-adjusted life years (DALYs) by age, sex, region, and sociodemographic index (SDI). Temporal trends were evaluated using estimated annual percentage change (EAPC), and future burden through 2035 was projected using a Bayesian age-period-cohort model.

Globally, the absolute burden of SP increased substantially between 1990 and 2021. LBP prevalent cases increased from 386.7 million to 628.8 million, whereas NP prevalent cases increased from 114.6 million to 206.0 million. Despite rising case numbers, age-standardized rates for LBP declined modestly, while NP rates remained relatively stable Females consistently experienced a higher burden than males, particularly among older adults. Considerable regional disparities were observed, with South Asia accounting for the largest number of LBP cases and North Africa and the Middle East showing the highest NP age-standardized burden. Projection analyses indicated that the absolute burden of SP will continue to rise through 2035, especially among elderly populations.

SP continues to represent a major global public health challenge driven by population aging, occupational exposure, and socioeconomic disparities. The projected increase in burden highlights the urgent need for targeted prevention strategies, improved rehabilitation services, ergonomic interventions, and equitable healthcare resource allocation, particularly for women and older adults.