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	Since this article does not have an abstract, we have provided the first 150 words of the full text and any section headings.

In Reply: In response to Dr Ratliff and colleagues, in this study our emphasis was on the discordance between spine-related expenditures and self-reported health status. During the study years 1997 to 2005, costs increased; instead of improvements, we noted worsening in physical limitations, work limitations, and social limitations and no improvement in scores on the 12-Item Short Form Health Survey. The diverging trends of increasing costs and worsening function should stimulate discussion regarding efficient use of scarce health care resources.

The P value of .07 for the comparison of the relative increase in health expenditures for adults with spine problems and those without is the probability that the difference in the increases is due to chance alone. The point estimate of a 65% increase in inflation-adjusted costs for spine-related care is not in question. We made both the point estimates and the probability clear. Any real increase in costs without . . . [Full Text of this Article]

Sohail K. Mirza, MD, MPH
mirza@u.washington.edu
Department of Orthopaedics & Sports Medicine
University of Washington
Seattle

Richard A. Deyo, MD, MPH
Department of Family Medicine
Oregon Health & Science University
Portland

Brook I. Martin, MPH
Department of Orthopaedics & Sports Medicine
University of Washington

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Spine-Related Expenditures and Self-reported Health Status
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