OBJECTIVES: A database analysis was carried out to study patient pathways for low back pain (LBP) conditions in England, with the later intention of identifying factors associated with success of spinal interventions. METHODS: A dataset linking UK Clinical Practice Research Datalink primary care data to English Hospital Episode Statistics data was acquired. Eligibility criteria included record of a primary care consultation with a diagnosis code from a set of LBP conditions during 1997-2013 inclusive. Patient analysis was stratified into nine LBP diagnostic subgroups. Patient pathways were characterised by defining broad categories (primary care consultation, injection, minimally invasive surgery, surgery) into which each consultation or intervention could be sorted; consecutive consultations or consecutive injections were considered as one event from the category. A brief signature then characterised the patients’ temporal sequence of these events. RESULTS: For every LBP condition considered, the majority of patients, between 54.5% and 87.6%, only had primary care consultations recorded for their back pain. The majority of patients who only attended their GP did so once or twice, or infrequently if more than twice. Between 66.3% and 81.3% of patients, across diagnostic subgroups with >100 patients, had only one major secondary care event; in these groups the nine most common patterns accounted for 86.4%-93.3% of patients with secondary care events. The largest pattern groups among patients admitted to secondary care were those only ever admitted for injection(s), including epidural injections, however, in almost all LBP diagnostic subgroups, the five most common patterns included some type of invasive surgery. Facet joint denervations and decompressions were common. CONCLUSIONS: This database analysis yielded patient pathway information in concordance with expectations. Although most patients did not attend secondary care, surgical interventions were still common. A better understanding of the reasons for these interventions and the likelihood of success would be beneficial.