The number of economic evaluations in the field of spinal disorders and methodological studies have increased in the last decade. The objective of this paper is to provide an overview of current views on economic evaluations in the field of spinal disorders and to facilitate clinicians to interpret and use results from these studies. A full economic evaluation compares both costs and effects of two or more interventions. Key elements of economic evaluations such as identifying adequate alternatives, analytical perspective, cost methodology, missing values and sensitivity analyses are addressed. Further emphasis is placed on the interpretation of results of economic evaluations conducted alongside randomised clinical trials. Incremental cost-effectiveness ratios, cost-effectiveness planes, acceptability curves and cost-effectiveness thresholds are discussed. The contents may aid in taking the efficacy 'hurdle' in the field of spinal disorders. © Springer-Verlag 2005.