Background: Spinal anesthesia is a kind of central neuraxial anesthesia and a better choice forrnoperations below the umbilicus. However most patients refuse it for future surgeries because ofrnpost-spinal back pain. rnObjective: To assess the Incidence, severity and associated factors of back pain after spinalrnanesthesia in surgical patients at Addis Ababa governmental hospitals. rnMethods: Multi-center prospective observational study was conducted in 404 patients operatedrnunder spinal anesthesia at selected Addis Ababa governmental hospitals from February 1-Aprilrn30,2021. A systematic random sampling technique was used to select the patients. A structuredrnquestionnaire was used to collect the data. Back pain after Spinal anesthesia was assessed using arnnumeric pain rating scale. The data was analyzed with Statistical software version 24. The datarnwas described by texts, tables, and graphs. Binary logistic regression was used to see thernassociation between each independent variable with dependent variable. A P-value < 0.05 wasrnconsidered statistically significant. rnResults: The overall incidence of back pain was 42.32%. The Mean severity of back pain in eachrnthree post-operative days was mild to moderate. Body mass index, history of backache, spinalrnneedle size, number of attempts, and number bone contacts were associated with the incidence ofrnacute post-spinal backache. rnConclusion: The incidence of back pain was high at Addis Ababa governmental hospitals. Tornminimize this, the anesthesia provider should use fine-gauge spinal needle, minimize multiplernattempts and multiple bone contacts.