Low back pain is a common cause of disability and reason for seeking medical care. Surgery rates for low back pain are escalating, and the overall costs exceed $1 billion. Primary care physicians are increasingly responsible for the initial evaluations and management of these individuals. Recognition of surgical indications by these physicians will decrease costs by initiating management and will limit morbidity by expediting appropriate referrals. The important aspects of the evaluation of low back pain are reviewed in this article. Surgical indications in low back pain including infection, tumor, degenerative conditions, and nonacute traumatic sequelae are discussed.