Spine surgery has made radical advancements in the last two decades and provision has expanded a great deal. The history of the technical development is briefly reviewed. To analyze trends in utilization and to assess the macroeconomic demand for spine surgery, the incidence of all spine surgery per capita is estimated referring to diverse statistical data from the USA, Korea and Japan. When compared internationally, there is a great disparity in the utilization of spine surgery, especially for fusion/instrumentation. Medico-socioeconomic conditions underlying the variations are discussed. Adequate surgeon training has to be supplied in a matched volume, and the number of surgeons to balance the need is estimated.