Pelvic ring instability syndrome is a condition in which reduced stability of the sacroiliac joints (SIJs) and pubic symphysis leads to chronic low back, buttock, and pubic pain. Hormone-induced ligament laxity during pregnancy increases the vulnerability of the pelvic ring, and excessive mechanical load can result in structural failure of the SIJs and pubic symphysis. The SIJ has been reported as the most frequent and most painful source of lumbopelvic pain during pregnancy and after childbirth, and persistent cases seen in orthopedic clinics often show localized pain at the SIJ and pubic symphysis. In our treatment strategy for SIJ disorder caused by pelvic ring instability, a functional pelvic belt is applied to stabilize the entire pelvic ring including the pubic symphysis. In addition, transverse abdominis training is performed to enhance joint stiffness. Ultrasound-guided prolotherapy to the posterior SIJ ligaments is added when necessary. Although SIJ fusion may be required in severe cases, conservative management should be prioritized by gradually reducing pain with SIJ injections and by providing therapeutic exercise and movement retraining in collaboration with physical therapists who are experienced in postpartum lumbopelvic pain.

The authors reviewed previous articles on postpartum low back pain/pelvic girdle pain, as well as results from the authors' experience. The frequency of postpartum low back pain/pelvic girdle pain varies depending on its location and severity, the timing of assessment, and the survey method. Therefore, comparison of results becomes possible by standardizing pain intensity assessment using a visual analog scales (VAS) or numerical rating scale (NRS) and the timing of the survey. Past reports often defined clinical pain as VAS or NRS scores of ≥ 4. Appropriate assessment time points are 4 to 6 months postpartum, when symptoms typically resolve in patients with few risk factors, and 1 and a maximum of 2 years postpartum, considering the pregnancy-childbirth cycle. Factors associated with persistent or worsening pain include a history of low-back pain, reduced trunk muscle strength, pain in multiple sites, psychosocial factors such as depression, and pelvic ligament laxity. Due to differences in the evaluation methods and timing used, meta-analyses and systematic reviews have not yielded clear conclusions regarding the factors associated with persistence and/or exacerbation. Though numerous treatment options exist, none can be strongly recommended. However, patient education, exercise therapy, pelvic belts, and acupuncture are generally recommended. Postpartum low back pain/pelvic girdle pain requires a multidisciplinary team approach involving orthopedic surgeons, obstetrics and gynecologists, nurses (midwives), and rehabilitation therapists. In particular, patients experiencing severe pain before or during early pregnancy requires early treatment intervention because of high pain intensity after delivery.

Postpartum women who experience difficulties in daily life due to low back pain are in a transitional period of becoming parents, during which factors arising from ongoing interactions with their children are constantly present. To appropriately understand postpartum low back pain, it is necessary to view the mother and child as a single unit and to interpret symptoms within the context of daily life from pregnancy through the postpartum period.

Although various intervention methods for low back pain in pregnant and postpartum women have been proposed, it is difficult to achieve sufficient effectiveness during pregnancy or while caring for an infant by adopting only a single approach that targets underlying physical mechanisms. In the postpartum period in particular, low back pain may be triggered or exacerbated by activities related to childcare, such as breastfeeding and caring for the infant.

Therefore, postpartum women whose daily lives are affected by low back pain require a multifactorial approach that combines multiple strategies tailored to the specific situations in which low back pain occurs within the context of childcare. This includes identifying individual factors contributing to low back pain, focusing on actions that postpartum women can implement themselves, and supporting them in selecting and acquiring concrete methods for managing their symptoms. Furthermore, it is essential to enhance women's capacity to adapt these coping strategies and to implement them effectively within their childcare routines.

To achieve this, postpartum women require support and interaction that enable them to develop awareness and knowledge of low back pain and its management, make informed judgments and decisions, practice self-care, and evaluate and readjust their condition as needed.

Postpartum low back pain (LBP) is the most frequent minor complaint of perinatal women. Epidemiological studies report that 30% to 90% of pregnant and postpartum women have LBP, and 21.1% still report symptoms two years after delivery. This indicates that LBP can persist from pregnancy into the long-term postpartum period, representing a serious clinical issue.

Physical changes associated with pregnancy and childbirth include increased pelvic girdle instability due to hormonal shifts, as well as alterations in spinal-pelvic alignment and a decrease in postural control. Following delivery, these changes combined with increased mechanical stress on the lumbar and pelvic tissues during childcare activities can contribute to the development of LBP and pelvic girdle pain. Postpartum LBP limits activities of daily living and interferes with childcare, ultimately affecting long-term health status and quality of life (QOL). Physical therapy for postpartum LBP requires thorough risk management, including a detailed medical history of the pregnancy and delivery process.

Furthermore, physical therapy assessments must be conducted with careful consideration of excessive movement and exercise load, depending on the postpartum period. Based on these evaluations, therapeutic exercises such as stabilization exercises for the lumbar and pelvic regions and motor control exercises with gradually increasing intensity are considered effective interventions.

With the increasing importance of evidence-based medicine, physical therapists are expected not only to apply scientifically grounded assessments and interventions but also to generate evidence through routine clinical practice. At our Spine Care Center, we have established a systematic data collection framework using patient-reported outcome measures and objective physical function assessments, and have conducted clinical research through multidisciplinary collaboration. Clinical studies focusing on lumbar spinal stenosis and osteoporotic vertebral fractures have suggested the effectiveness of physical therapy interventions and their contribution to the prevention of postoperative complications. Integrating clinical research with routine clinical practice provides a foundation for enhancing the professional expertise of physical therapists in both clinical and research domains. Furthermore, these initiatives extend beyond strengthening in-hospital collaboration, expanding into research activities outside the institution and potentially contributing to the development of evidence in physical therapy. This article outlines the research activities of physical therapists at our Spine Care Center and summarizes their outcomes.

Pain centers have been established nationwide in Japan as part of an initiative led by the Ministry of Health, Labour and Welfare to standardize and enhance the quality of chronic pain management through multidisciplinary care. Chronic pain is characterized by complex interactions among physical, neurological, psychological, and social factors. Therefore, contemporary treatment strategies emphasize not only the reduction of pain intensity, but also the preservation and restoration of functional capacity and social participation. In particular, lifestyle management, including physical activity, sleep, nutrition, and stress regulation, has been positioned as a cornerstone of chronic low back pain management.

Exercise therapy constitutes a central component of chronic pain rehabilitation, and its analgesic effects are partly mediated by exercise-induced hypoalgesia (EIH), a phenomenon supported by accumulating neurophysiological evidence. However, the expression of EIH shows marked inter-individual variability, and its attenuation due to aging, dysfunction of pain modulatory systems, and psychosocial factors represents a significant clinical challenge, often contributing to reduced exercise adherence in patients with chronic pain.

Recently, behavior change support incorporating goal-setting approaches, such as Goal Attainment Scaling (GAS), has attracted attention for its ability to promote active patient engagement and improve adherence to exercise-based and multimodal interventions. Within pain centers, physiotherapists play a pivotal role by delivering exercise therapy grounded in comprehensive, multidimensional assessments that integrate lifestyle-related factors. Through such an integrative approach, physiotherapists may contribute not only to pain management but also to the restoration of social roles and meaningful improvements in daily functioning in individuals with chronic low back pain.

Locomotive syndrome is a condition characterized by reduced mobility due to impairment of the musculoskeletal system and is closely associated with an increased risk of requiring long-term care. In patients with lumbar spine disorders, decreased physical activity resulting from pain and neurological symptoms may accelerate the progression of locomotive syndrome and adversely affect postoperative recovery.

This review outlines the concept and assessment methods of Locomotive syndrome and summarizes its relationship with lumbar spine disorders, as well as our institution's postoperative follow-up system and community-based awareness activities. In the postoperative follow-up program, locomotive syndrome assessment is used to estimate the risk of delayed recovery and to support improvements across multiple functional domains. However, some patients classified as having mild locomotive syndrome at discharge demonstrated functional decline after surgery, suggesting the presence of a latent high-risk group that may not be fully identified by the current system.

These initiatives may contribute to an integrated strategy for preventing locomotive syndrome that links the perioperative and community phases. Nevertheless, strengthening continuous follow-up systems, including patients with mild impairment, remains an important future challenge.

Introduction: The efficacy of condoliase intradiscal injection therapy for lumbar disc herniation was investigated in older patients, and complications specific to this population were examined.

Methods: This study included 227 consecutive patients (144 males, 83 females) who underwent condoliase injection therapy between December 2018 and March 2024. Their mean age was 46.2 (range: 15-89) years. Clinical outcomes included visual analogue scale (VAS) scores for leg pain assessed before injection and 1, 3, and 6 months post-injection. A reduction of the leg pain VAS to half or less compared with pre-injection was defined as "effective". On imaging evaluation, the presence of thickening of the ligament flavum was assessed on pre-injection magnetic resonance imaging (MRI).

Results: Comparing the elderly group aged 65 years or older (E group, 47 cases) with the other group (O group, 180 cases), the proportion of effective cases at 3 and 6 months post-injection was significantly lower in the E group (3 months post-injection, E group 62.2% vs O group 80.7%, p=0.018; 6 months post-injection, E group 56.7% vs O group 92.3%, p<0.0001). In addition, the E group had a significantly higher prevalence of ligamentum flavum thickening (E group 46.8% vs O group 3.9%, p<0.0001). Complications included one case of adjacent vertebral body fracture and one case of worsening lumbar spinal stenosis symptoms after injection.

Conclusions: In patients aged 65 years or older, ligamentum flavum thickening was common, and the efficacy rate at 3 and 6 months after injection was low, suggesting that the indications should be considered with caution. In addition, complications specific to older patients were observed, necessitating careful monitoring of the patients' courses.

Introduction: We investigated patients in whom multiple myeloma was suspected following fresh vertebral body fractures.

Methods: We conducted a retrospective study of patients diagnosed with fresh vertebral fractures at our hospital between January 2021 and March 2025, focusing on those suspected of having multiple myeloma. We investigated patient background, test results, imaging data, and outcomes when M protein was detected. Statistical analysis comparing the presence or absence of findings in patients diagnosed with M-proteinemia or multiple myeloma was performed between the two groups.

Results: The study included 71 patients. M protein was detected in 17 patients; 9 were diagnosed with Monoclonal gammopathy of undetermined significance and all were placed under observation. Six were diagnosed with symptomatic myeloma and were scheduled for chemotherapy. Additionally, one patient was diagnosed with Sjögren's syndrome and one with M-proteinemia due to interstitial pneumonia. M-proteinemia showed significant differences in blood calcium levels and characteristic MRI findings, while multiple myeloma showed significant differences in age, blood albumin levels, and albumin/globulin ratio.

Conclusions: Detecting M protein alone is insufficient for diagnosing multiple myeloma in patients with vertebral body fractures; referral to hematology for differential diagnosis is essential.

Introduction: A retrospective review of surgically treated cases of osteoporotic vertebral fracture (OVF) with delayed union, non-union, and pseudoarthrosis in our hospital was performed.

Methods: The study population included 30 patients with thoracolumbar OVF who underwent surgery after failing to achieve bone union despite conservative treatment for greater than three months. The study investigated: the affected vertebral bodies; the duration from symptom onset to initial consultation with a physician; the time to computed tomography (CT) and magnetic resonance imaging (MRI); the time to admission at our hospital; the presence or absence of CT and MRI non-union risk; the breakdown of initial consulting physicians and whether hospitalization occurred; the progression of osteoporosis treatment; perioperative complications; and changes in activities of daily living (ADL) before and after surgery.

Results: OVFs were located in the thoracolumbar junction in 62% of cases. The time from symptom onset to CT was 76.0 days and to MRI was 58.6 days. Posterior wall injury was present on CT in 85% of cases, and 82% of cases showed MRI risk factors for non-union (extensive T1WI diffuse low signal or extensive T2WI diffuse low signal or focal T2WI confined high signal intensity). At the time of referral to our hospital, 37% had not received osteoporosis treatment. Perioperative complications occurred in 40% (mild) and 43% (severe) of cases. Mobility improved or was maintained compared with preoperative levels in 57% of patients at final follow-up.

Conclusion: OVF may become refractory if acute-phase treatment is mismanaged, making prompt and thorough investigation, diagnosis, and therapeutic intervention crucial.

Introduction: Patient-specific guides (PSGs) have shown excellent accuracy for midline cortical (MC) screw insertion in lumbar fusion. However, their accuracy in post-laminectomy cases with limited remaining lamina remains unknown. This study evaluated the accuracy of MC screw insertion using PSGs in post-laminectomy vertebrae.

Methods: Forty-four patients who underwent lumbar fusion with MC screw insertion using PSGs between August 2023 and September 2025 were reviewed retrospectively. A total of 167 screws were placed in 84 vertebrae; 22 screws in 11 vertebrae were inserted into post-laminectomy levels in 7 patients. Screw accuracy was assessed using Gertzbein's classification on postoperative computed tomography (CT). Grades 0 and 1 were considered clinically acceptable. Early complications including neurological deficits, infection, adjacent segment disease, pars fractures, and pedicle fractures were recorded.

Results: Overall, 157 screws (94.0%) achieved Grade 0, 9 (5.4%) Grade 1, 1 (0.6%) Grade 2, and none Grade 3. Clinically acceptable accuracy was 99.4% (166/167 screws). All deviations were lateral with no canal encroachment. For post-laminectomy vertebrae, 21 screws (95.5%) were Grade 0 and 1 (4.5%) Grade 1, achieving 100% acceptable accuracy. No guide placement was abandoned in lumbar levels. The residual lamina and medial facet provided stable landmarks for guide placement in all post-laminectomy cases. No early complications occurred in post-laminectomy vertebrae.

Conclusions: MC screw insertion using PSGs maintained high accuracy in post-laminectomy cases. The residual lamina and medial facet provided adequate anatomical landmarks for guide placement despite previous laminectomy. These results suggest that PSG use should not be avoided solely due to prior laminectomy. Although the sample size was limited, this study demonstrates that MC screw insertion using PSGs is feasible and safe in revision lumbar fusion surgery.

Introduction: Turning movements often provoke lumbogluteal pain in patients with sacroiliac joint disorder (SIJD) and lumbar spine diseases. This study investigated the effects of pillow height adjustment on turning time and turning-related pain.

Methods: Between August 2020 and October 2022, 26 hospitalized patients with turning-related lumbogluteal pain (11 with SIJD and 15 with lumbar spine diseases) were included. As an intervention, the height of an orthopedic pillow was adjusted using the Set-up for Spinal Sleep method. Turning time and turning-related pain (visual analog scale) were assessed, and changes before and after adjustment were compared within and between groups.

Results: Age differed significantly between groups (SIJD: 52.4±13.1 years; lumbar: 64.3±13.6 years, p = 0.042), whereas height, weight, and BMI showed no significant differences.

Turning time significantly shortened after pillow adjustment in both groups (SIJD: from 12.2±4.5 to 8.5±2.3 s; lumbar: from 9.7±5.3 to 6.6±3.4 s).

Turning-related pain improved significantly in the lumbar group (from 31.6±18.9 to 14.0±14.6 mm; p = 0.007), but no significant change was observed in the SIJD group (from 44.5±20.3 to 32.2±22.1 mm; p = 0.062), although pain decreased in 6 of 11 patients.

No significant between-group differences were observed in the improvement amounts for turning time or turning-related pain.

Conclusions: Use of the orthopedic pillow improved turning time in both groups, and reduction in turning-related pain was particularly evident in patients with lumbar spine disorders. Height adjustment of the pillow may be a worthwhile intervention to consider in patients with turning difficulties associated with SIJD or lumbar spine diseases.

Background: Facet sagittalization is an important factor in the pathogenesis of lumbar degenerative spondylolisthesis (LDS). However, the clinical significance of facet tropism (FT), defined as asymmetry of the facet joints, remains unclear. The purpose of this study was to compare the prevalence of FT across different age groups in patients with LDS and to evaluate its relationship with age-related changes.

Methods: This study included 160 patients, consisting of 20 male and 20 female patients in each decade from the 50s to the 80s, who underwent surgery for L4-5 LDS. A total of 320 facet joints were analyzed. Facet joint angles were measured on axial computed tomography images obtained at the level of the superior endplate of the L5 vertebral body. FT was defined as a right-left difference in facet joint angle ≥ 8°. The prevalence of FT was compared among age groups and between sexes.

Results: The facet joint angle decreased significantly with age. FT was identified in 22 patients in their 50s (55.0%), 20 patients in their 60s (50.0%), 15 patients in their 70s (37.5%), and 20 patients in their 80s (50.0%). No statistically significant differences in the prevalence of FT were observed among age groups and between sexes.

Conclusions: FT was observed at a relatively constant frequency regardless of age or sex in patients with LDS. These findings suggest that FT may be associated with LDS and that its presence is not solely attributable to age-related changes in facet joint morphology.

Background: There is no consensus on conservative treatment for adult spinal deformity (ASD). The purpose of this study was to compare the clinical outcomes of conservative treatment with exercise rehabilitation intervention using FitCure Spine^® (FCS), a simple brace with a stay supporting lumbar lordosis, with those of surgical cases.

Methods: This was a non-interventional, observational study comparing patients at two institutions. Propensity score matching using pre-intervention age, PI, PT, SVA, and PI-LL as covariates was performed to compare two groups: 8 cases treated conservatively at our hospital (Group C) and 127 ASD surgical patients treated at Dokkyo Medical University Saitama Medical Center (Group S).

Results: After matching (7 cases in each group), Group S was significantly larger Cobb angles (p=0.026). Post-intervention, Group S showed significantly better outcomes for PT (p=0.003), LL (p=0.010), PI-LL (p=0.003), and ODI (p=0.010).

Conclusion: Conservative treatment using FCS for patients with severe ASD can be expected to yield some improvement in health-related quality of life at 6 months. However, it is inferior to surgical treatment. Though it may be appropriate to propose this approach to elderly patients for whom surgical treatment may be difficult, its effectiveness is limited.

Introduction: Thoracolumbar spine fractures are frequently encountered in the elderly population, and physiological frailty and reduced nutritional reserves often complicate perioperative recovery. Although percutaneous pedicle screw fixation (PPS) has become a widely accepted minimally invasive treatment for elderly patients, postoperative oral intake and nutritional sufficiency have not been well investigated in this group.

Objective: To evaluate the daily changes in dietary intake during the perioperative period and the rate of achieving estimated energy requirements in elderly patients undergoing PPS for thoracolumbar spine fractures.

Methods: This retrospective study included 39 patients aged ≥70 years who underwent PPS between January 2022 and October 2025. Daily oral intake from the day before surgery to postoperative day (POD) 7 was assessed using a 0-100% scale based on nursing records. Estimated energy requirements were calculated using the Harris-Benedict equation with activity and stress factors. The proportion of patients whose intake was <60% of the requirement was examined. Perioperative laboratory values, including the Geriatric Nutritional Risk Index (GNRI), hemoglobin, and albumin, as well as IVPCA use, were also evaluated.

Results: The mean age was 82 years. Average dietary intake decreased from 70% preoperatively to 36% on POD1, followed by gradual recovery to 70% by POD7. The proportion of patients with intake <60% of estimated requirements increased from 28% preoperatively to 82% on POD1 and remained 33% on POD7. Albumin levels decreased from 3.6 g/dL preoperatively to 3.0 g/dL immediately postoperatively and remained stable at 2.9 g/dL on POD7.

Conclusions: Elderly patients undergoing PPS for thoracolumbar fractures experienced a marked reduction in oral intake during the early postoperative period, with a substantial proportion failing to meet 60% of estimated energy requirements even after one week. These findings highlight the challenges of ensuring adequate early oral intake in this population and suggest the importance of preoperative nutritional assessment and risk stratification.

Introduction: Acute osteoporotic vertebral fractures (OVFs) with intravertebral bone defects have shown greater progression of vertebral collapse than other fracture types in our clinical experience. This study aimed to investigate the characteristics of intravertebral bone defects observed soon after fracture onset.

Methods: A total of 1,061 patients (1,299 vertebrae) diagnosed as having OVFs at our hosipital between April 2016 and March 2023 were retrospectively reviewed. Patients who underwent computed tomography (CT) and magnetic resonance imaging (MRI) clearly within 7 days after symptom onset were included. An intravertebral bone defect was defined by CT as a well-defined intravertebral low-density area (height>1 mm) formed horizontally. Chronic clefts and bone defects observed in reverse Chance fractures associated with diffuse idiopathic skeletal hyperosteosis (DISH) were excluded from intravertebral defects. Injury mechanisms, affected levels, and lumbar spine young adult mean (YAM) values were recorded. Associations between these clinical factors and intravertebral bone defects were evaluated. Intensity changes on MRI T2-weighted images at the corresponding region were also assessed.

Results: Intravertebral bone defects were identified in 226 of 1,299 vertebrae (17.4%). 46% of defects were detected within 1 day after onset. Patients with defects most frequently sustained injuries from falls (67.7% of cases). Defects occurred more often at the thoracolumbar junction (T11-L1, 65.9%; p<0.05). YAM values did not differ significantly between vertebrae with defects (mean 67.3%) and those without defects (mean 64.4%; p=0.056). MRI T2-weighted intensity changes in the area corresponding to defects varied from high to low. The most common pattern was a homogeneous hyperintensity with a peripheral hypointense rim, accounting for approximately 30% of defects.

Conclusions: Intravertebral bone defects detected shortly after acute OVFs are relatively common. Most defects appear immediately after symptom onset and likely represent fracture voids. These defects indicate significant structural vulnerability of the affected vertebrae. CT is essential for their detection because MRI alone identifies only a portion of these lesions.

Background: Vertebral bone quality (VBQ) is a magnetic resonance imaging (MRI)-derived index based on T1-weighted signal intensity and is considered to reflect vertebral marrow adiposity. As a marker of skeletal fragility, VBQ may complement dual-energy X-ray absorptiometry (DXA), particularly in older patients with adult spinal deformity (ASD). Malnutrition is common in patients with ASD and may contribute to impaired bone quality, yet the relationship between nutritional status and VBQ remains unclear.

Methods: A total of 99 consecutive women who underwent posterior corrective surgery for ASD at a single institution (long thoracolumbar fusion including pelvic fixation) and who had both preoperative lumbar MRI and nutritional screening were retrospectively reviewed. Nutritional status was assessed using the Mini Nutritional Assessment-Short Form (MNA-SF). VBQ was calculated on mid-sagittal T1-weighted images by placing regions of interest within trabecular bone of L1-L4, measuring mean signal intensity (SI) at each level, taking the median SI across L1-L4, and normalizing it by the cerebrospinal fluid SI measured in the spinal canal at the dorsal aspect of L3. Demographic and clinical variables (age, body mass index [BMI], DXA-derived percent young adult mean [YAM], serum albumin [Alb], and MNA-SF) were collected. Associations with VBQ were tested using Spearman's rank correlation coefficients.

Results: Mean age was 71.2±8.0 years, and mean BMI was 22.8±4.0 kg/m^2. Mean YAM was 73.8±14.0%, consistent with low bone mass. Alb averaged 4.3±0.4 g/dL, whereas the mean MNA-SF score was 11±2, indicating that many patients were at risk of malnutrition. Mean VBQ was 3.6±0.9. VBQ correlated negatively with YAM (r = −0.39, p = 0.003), indicating higher VBQ values in patients with lower DXA-based bone density. Importantly, VBQ also correlated negatively with MNA-SF (r = −0.36, p = 0.015), suggesting that poorer nutritional status was associated with higher VBQ (greater marrow adiposity). VBQ was not significantly correlated with age, BMI, or Alb (all p > 0.05).

Conclusions: In women undergoing surgery for ASD, MRI-derived VBQ was associated not only with DXA-based bone density, but also with nutritional risk assessed by MNA-SF. Combining rapid outpatient nutritional screening with VBQ may improve preoperative identification of patients at heightened skeletal vulnerability and support integrated optimization of nutrition and bone health. This single-center, cross-sectional design and inclusion of women only preclude causal inference and limit generalizability to broader ASD populations. Prospective, multicenter studies should clarify causality and determine whether nutritional and osteoporosis interventions can modify VBQ and improve postoperative outcomes.

Introduction: Nonspecific low back pain is defined as low back pain for which a cause cannot be identified through imaging and diagnostic injections. Functional assessments occasionally show that there is no single cause of the low back pain, but rather that it is associated with overlapping functional disorders of the trunk and lower limbs. Although these patients would be classified into the nonspecific category under the conventional orthopedic diagnostic process, functional disorders may improve with continued physical therapy. This study investigated the functional assessment and treatment outcomes of patients with nonspecific low back pain.

Methods: This study included 35 patients (11 men and 24 women, mean age: 58.4±14.1 years) who were hospitalized for low back and buttock pain between April 2024 and March 2025. A definitive diagnosis could not be made in these patients through imaging and various diagnostic injections. The assessment criteria included: 1) the presence or absence of functional impairment in 10 physical findings; 2) the average number of functional impairments; and 3) treatment outcomes (based on the Macnab criteria; "excellent" and "good" representing good outcomes, "fair" and "poor" representing unchanged poor outcomes). The treatment intervention consisted of physical therapy tailored to the functional impairments.

Results: The most common functional impairment was decreased transversus abdominis muscle function (30 patients, 85.7%), followed by lumbar spine range of motion restriction/poor movement (25 patients each, 71.4%), hip joint range of motion restriction/hip joint muscle weakness (20 patients each, 57.1%), decreased multifidus muscle function (19 patients, 54.3%), thigh dysfunction/foot and toe dysfunction (15 patients each, 42.9%), and decreased pelvic floor muscle function/lower leg dysfunction (12 patients each, 34.3%). The average number of functional impairments was 5.5±2.2 items. Treatment outcomes were good in 25 patients (9 men and 16 women, 71.4%) and unchanged/poor in 10 patients (2 men and 8 women, 28.6%) (P=0.017).

Conclusions: Nonspecific low back pain may not originate from a single muscle or joint, and it is often associated with functional impairments involving multiple regions, including the trunk, pelvis, and lower limbs. When nonspecific low back pain was considered as an accumulation of functional impairments based on functional assessments, good treatment outcomes were achieved in approximately 70% of patients. These findings suggest that physical therapy may be effective in managing overlapping functional impairments in patients with nonspecific low back pain.

Objective: This study aimed to evaluate the clinical outcomes of an ultra-aggressive physical therapy approach designed to achieve bone union while simultaneously correcting causative movement patterns from an early stage after diagnosis in patients with very early and early-stage lumbar spondylolysis.

Methods: A retrospective cohort study involving 17 patients diagnosed with very early or early-stage lumbar spondylolysis between April 2017 and March 2024 was conducted. Their mean age was 15.0±2.1 years. Ultra-aggressive physical therapy, consisting of exercise-based therapy combined with patient education and brace treatment, was started one week after diagnosis. Outcome measures included bone union rate, time to bone union, and time to full return to sports. Bone union was assessed using magnetic resonance imaging and computed tomography.

Results: Bone union was achieved in all patients (100%), including 2 very early-stage cases, 13 unilateral early-stage cases, and 2 bilateral early-stage cases. The mean time to bone union was 2.0±0.06 months for very early-stage cases, 2.7±0.4 months for unilateral early-stage cases, and 2.7±0.6 months for bilateral early-stage cases; the mean time to full return to sports was 1.0±0.1 months, 1.4±0.6 months, and 1.5±0.4 months, respectively. All patients were able to resume sports activities prior to radiological confirmation of bone union.

Conclusion: Ultra-aggressive physical therapy started during the very early and early stages of lumbar spondylolysis resulted in a high bone union rate comparable to conventional treatment, while allowing an earlier return to sports. This integrated approach may be a promising therapeutic option for adolescent athletes.

Introduction: We classified the T2 high intensity zone (HIZ) within the herniation as a prognostic factor for condoliase intradiscal injection therapy for lumbar disc herniation and examined its progression.

Methods: We included 131 patients who underwent condoliase injection therapy at least 6 months of follow-up between January 2019 and January 2024. Clinical outcomes were assessed using the Visual Analogue Scale (VAS) for leg pain before injection and at 1-, 3-, and 6-months post-injection, with a reduction to half or less of the pre-injection score defined as "effective". Imaging evaluation used MRI to classify herniation size and the presence of HIZ within the herniation into three types: type 0 (no HIZ), type 1 (indistinct HIZ present), and type 2 (distinct HIZ with a tumor-like appearance present).

Results: Leg pain VAS improved over time, with mean values of 7.1 cm before injection, 3.3 cm at 1 month, 2.1 cm at 3 months, and 1.7 cm at 6 months. Herniation size also decreased over time. Regarding HIZ progression, cases changing from type 0 or type 1 to type 2 often subsequently showed herniation reduction and reversion to type 0. Comparing the 15 cases that changed to HIZ type 2 one month after injection (T2 group) with the remaining 116 cases (O group), the T2 group showed a higher proportion of effective cases (1 month post-injection: T2 group 80.0% vs O group 54.3%, p=0.063; 3 months post-injection T2 group 100% vs O group 76.7%, p=0.043), and the herniation showed greater reduction at 3 months post-injection (reduction rate T2 group −67.1% vs O group −46.2%, p=0.0083).

Conclusions: Cases that changed to HIZ type 2 one month after injection subsequently showed hernia reduction and had a high proportion of effective cases.

Introduction: The purpose of this study was to investigate whether the presence of Modic changes, or differences in their types, affect the efficacy of exercise therapy in patients with symptomatic degenerative lumbar diseases.

Methods: A total of 212 patients who had degenerative lumbar diseases with the complaint of low back pain and had received outpatient exercise therapy in our hospital were included in this retrospective, cohort study. These participants were divided into two groups: with and without Modic changes (MC [+] (n=66) and MC [−] (n=146) groups, respectively). The MC (+) group had 16 Type 1 and 50 Type 2 cases. Clinical results were compared between the groups at 1 and 3 months post-treatment using a visual analogue scale (VAS), the Oswestry Disability Index (ODI), and the Japanese Orthopaedic Association Back Pain Evaluation Questionnaire (JOABPEQ).

Results: Both MC (+) and (−) groups and the Type 2 group showed significant decreases in VAS and ODI scores at 1 and 3 months post-treatment compared with pre-treatment. The Type 1 group showed a significant decrease in the VAS scores, but no significant difference in the ODI scores at 1 month post-treatment. Moreover, the Type 1 group had significantly lower increased scores for low back pain, walking ability, and mental health on the JOABPEQ than the Type 2 group.

Conclusions: Patients with degenerative lumbar diseases who complain of low back pain showed improvement with exercise therapy. However, patients with Type 1 Modic change showed a low degree of improvement in daily living disability and quality of life. Patients with Type 1 Modic change may require different treatment approaches to achieve long-term improvement.