There are less investigations on low back pain in office workers than those in physical workers. The object of this crosssectional study is the first step of a prospective research to investigate occupational and non occupational factors of low back pain in VDT (Video Display Terminals) workers. The prevalence of low back pain and the working conditions were investigated in the 237 workers who engaged in the VDT operations. Almost 30% of the workers complained of low back pain regardless of sex. In about half of them, low back pain had first occurred after having started working. Among the women in twenties and thirties who held a majority and had relatively uniform working conditions, occupational and non occupational factors are compared among three groups, having no low back pain, low back pain only in working and low back pain in daily life. Only the working years in the last group was longer than that in the other groups.

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We interviewed the patients with low back pain to investigate the hypothesis that lower back pain is largely related to daily activities.
Subjects comprised 1, 071 patients (553men, 518women), with range of aga from 20 to 65 years who had visited our hospital during June 1983 to May 1984. The patients were interviewed indivisually, and asked the following 20 questionares regarding their daily activities. Compair with the results ten years ago, the use of soft bedding, Japanese-style toilets and high heels were decreased. However, the incidences of people experiencing chest pain and short of breath walking briskly or going up and down stairs increased. The most of clerical workers and computer operators who assume the same posture continuously felt low back pain after two hours. To adequately treat and prevent chronic low back pain. it is necessary to carry out a detailed study into the daily life and activities of individual paitients.

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The high incidence of low back pain among nurses and assistant nurses seem to beuniversal. It is known that heavy lifts, especially when performedin twisted, flexed positions, increase the risks for work-related low back pain.So nurses and assistant nurses are at higher risk for work-related low back pain.For analysis of causative and preventive factors influencing low back pain, questionnaire surver was carried out in 1994 on 1058 clinical nurses and assistant nurses. 733 nurses and assistant nurses occurred low back pain. 273 nurses and assistantnurses complained of continuous low back pain. 594 cases (81%) occurred low back pain after employment. 129 cases occurred low back pain within 2years after employment. Workplace risk factors are work shift, heavy work, lifting and bending, 666cases (77%) occurred low back pain by handling (including lifting and bending) and moving the patient. Most of nureses and assistant nurses complained that height of the bed was low for nursing and nursing space around the bed was narrow. So immediately after employment, it is essential for nurses and assistant nurses to be educated preventing workrelated low back pain. And working conditions need to be improved.

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Recently, the condition of clinical nurses is thought to be irrelevant to their working condition. We analyzed of low back pain among clinical nurses by means of questionnaire.It was revealed that low back pain was more frequently seen on nurses who were younger and with fewer years of experience, and on nurses who care patients with more serious condition. Additionally, it was provided that 96.5% of nurses with low back pain thought a potential relation between the occurence of low back pain and character of their works.Therefore, it was suggested that we must take measures to meet the situation toward low back pain immediately.

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Many literatures of clinical findings on lumbar disc herniation (LDH) were published, howeverthere are few reports which were studied on the relationship between condition of dorsalroot (DR) and clinical findings of LDH. We counted the number of the composing root ofDR on CTM at herniated disc level. Thirty-five patients with LDH were classified by thenumber of composing root of DR. DR which was formed by one root was classified to groupA (13 patients), and group B (22 patients) has more than two roots. Comparing with clinicalfeatures of two groups, we couldn't find out the difference between frequency of sensory disorderor SLR. But we find out significant difference in frequency of leg pain between groupA (46%) and group B (86%). Following these results, we concluded that clinical features ofLDH could be influenced by number of root composing of DR.

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The purpose of this report is to analysis the lumbar alignment on the jelly mat and hard mat. Fifteen peoples were examined with MRI from fifth thoracic spine to fifth sacral spine level on each mat. We measured pelvic angle (PA), lumbar lordosis (LL), thoracic kyphosis (TK), horizontal balance (HB) as parameters of lumbar alignment, and compared with obesity ratio.PA and LL were correlation with the obesity.Lumbar alignment at supine position was changed due to the mat. The jelly mat is useful for the people of the obesity ratio especially more than 18%.

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The treadmill were applied to the analysis of chronic low back pain and pain in the lower extremities. The subjects were 82 patients with degenerative lumbar disease which aggravates when walking or due to daily working and other loads. The recurrences and provocations of the low back pain or lower extremities pain were examined during walking on the treadmill. The response of the recurrences and provocations of the symptoms were divided into four grades. The reproduced symptoms after treadmill exercise were analyzed in terms of disease, symptom, effects of the posture, location of the tenderness and abnormal movement on the flexion-extension radiograph, and clinical symptomatic instability. As a results of it, there was no significant difference in symptom, location of the tenderness and abnormal movement on the flexion-extension radiograph. Reproduction rate of symptoms in the isthmic spondylolisthesis and the degenerative spondylolisthesis were higher in the canal stenosis and the herniated lumbar disk. Concerning effects of the posture, the patients which aggravates in the flexion were more sensitive than the patients which aggravates in the extension. The response in the treadmill exercise test manifests the dominant reflection of clinical symptoms suggesting clinical lumbar instability over the abnormal movements on the flexion-extension radiograph. Especially, the provocative test using treadmill were useful in of clinical lumbar instability without abnormal movement on the radiograph.

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It is widely accepted that a decrease in compressive stiffness of the intervertebral disc in the degenerated spine may destabilize the motion segement and cause chronic low back pain. However, diagnostic standards of this condition, often referred to as segmental instability, remain obscure. The purpose of this study was to identify specific roentgenographic evidence that might indicate segmental instability.
Roentgenographic measurements were made for comparison on ten parameters between the two following groups; “acute” low back pain group consisted of 30 patients and “chronic” low back pain group consisted of 26 patients. These 56 patients were selected from patients that had visited our outpatient clinic complaining of low back pain in 1988. Confirmation was made by telephone or by chart regarding duration of their symptom; patients were then classified into the two groups.
Narrowing of the disc space (p=0.001), traction spur formation (p=0.01), wedging of the disc space (p=0.03) and scoliosis (p=0.02) were more commonly seen on the roentgenograms of the chronic low back pain group than on those of the acute low back pain group. There was no difference between the two groups with respect to the prevalence of claw spur formation, auterior slipping, posterior slipping, lateral slipping, posterior widening of the disc space or vertebral sclerosis adjacent to the end plate.

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This clinical study reviewed the causative disease of low back pain in aged patient.
Objective: Recently twelve years, we experienced ninety-seven patients admitted to my hospital with low back pain. The age of these patients ranged from 65 to 90years-old (average; 70.6yrs.). Fifty-five patients were male and forty-two patients were female.
Results: The most common cause of low back pain was degenerative spondylosis deformans (68%), the next was metastatic spine tumor (13%).Others were primary spinal cord tumor (5%), spondylo-discitis (4%) and so on.Rarely, a case of chordoma was seen.
Conclusion: Spondylosis deformans was a common causes of low back pain in an aged patient.Careful consideration was necessary with the metastatic spine tumor.

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Low back pain is a common problem and has various fields of treatment. My patients experience indicates that maintaining correct posture is the most effective treatment. The follow study on my patients supports this argument. A follow up study was completed on patients who returned for treatment of lower back pain. Initial treatment involved teaching patients how to manage their posture in daily life. Muscle exercise was not stressed. The average interval between the first complaint and second visit was 4 years 9 months. During that period patients had not take back related medicine and did not do any abdominal or back exercises. Patients at the second visit atated their back pain was caused by poor posture maintenance, for example, not bending knees whilst lifting heavy objects. The duration ofthe second treatment averaged less than two weeks.During this treatment posture maintenance was once again emplasized, soon the patients lower back pain relented.Therefore, maintaining correct posture in daily life is the most effective treatment for lower back pain. It is for more effective than doing muscle exercise.

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Manual therapy is the interesting method for low back pain from the view point of biomechanics, arthrokinetic and neurological study.
Acute low back pain is sometimes cured by manipulation (facet technic) which releases hypomobility and locking of the facet joint. Functional anteroposterior radiographs demonstrate the improvement of lateral bending of lumber vertebra.
Disc technic is more least effective than facet technic, however disc technic can ease discoradicular conflict which is demonstrated by shrinkage of defect in myelography. We can see shrinkage of the herniated nucleus on MRI in the long term case.
Soft mobilization often relieves back pain because the hypomobile direction of the hypermobile facet is improved.

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The purpose of this study was to evaluate the effect of conservative treatment for lumber disc herniation (LDH). The level and location of LDH were defined by MRI before treatment in all cases. This study involved 56 patients. There were 35 men and 21 women with a mean age of 34 yeares. Follow-up period ranged from 12 months to 30 months. Out of the 56 patients, 2 (3.5%) had operative treatment, 9 (16%) were under treatment and 45 (80%) almost disappeared their symptoms and were not under treatment. The average period of conservative treatment was 7.1 weeks in 45 cases disappeared their symptoms. Of the period of conservative treatment in these cases, less than 4 weeks were in 20 cases (44%), from 5 to 8 weeks in 15 cases (33%), from 9 to 12 weeks in 8 cases (18%) and from 13 to 16 weeks were in 2 cases (4%). There was no relation between the size of herniated mass and the degree of improvement of symptoms. However, there were some cases with decrease in size of LDH. We realized the effect of conservative treatment for LDH. Therefore, surgical indication is based on the degree of their impairment and it must be considered after adequete conservative treatment.

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During 1981 to 1991, we operated on 331 patients with lumbar disc herniation. Nineteen cases out of those were reoperated due to the recurrence of symptoms. There were 17 males and 2 females with a mean of 45.7 years ranging from 16 to 67 years. The recurrence period ranged from 13 months to 10 years (mean, 3 years and 9 months).
The level of operated disc was L3/4 in 2 cases, L4/5 in 13, L5/S in 6, L5/6 in 2 in the initial operation. The surgical technique with Love's method was used in 15 cases, hemilaminectomy in 2, laminectomy in 1, and anterior body fusion in 1. The herniation recurred in the same site and same level on 10 cases, in the same level and the opposite site on 6 cases. Recurrence occurred in neiboring level on 3 cases.
The posterior approach was used in the reoperations with extripation of the recurrent disc herniations. Posterolateral fusion was performed in one case.
The improvement ratio of JOA scoring system for lumbar herniation was a mean of 76% at follow-up, and 11 out of 19cases returned to the same job.
Fat graft technique seems to be a useful method to prevent the scar formation around the dura in the operation of lumbar disc herniation.

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44 chronic low back pain patients (all wemen, 42-86 years, mean 64.6years) were examined the changes of the trunck flexion-extension mobility, and the patterns of back muscle EMG before and after the therapeutic exercise program.
This program was continued for three months.
Finishing this program, 36 patients decreased the back pain grade.
24 patients decreased that grade were observed silent position by back muscle EMG in forward flexion, but twelve patients were not observed that phenomenone. In 24 patients, forward flexion and total mobility were increased finishing this program, but extension mobility was not changed. 19 patients increased the trunck mobility were observed silent position by back muscle EMG during forward flexion.
But 5 patients were not observed that phenomenone. Consequently, the therapeutic exercise was effective for low back pain patients.
But 5 patients were not observed that phenomenone. Consequently, the therapeutic exercise was effective for low back pain patients.

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A new trunk-extension exercise machine (BACKTECH back machine) was used for the treatment of 18 low back patients of 32 to 74 years of age(mean 53 years). The diagnosis was spondylosis in ten patients, disc herniation in five patients, and canal stenosis in three patients. A program for the exercise was two sessions per week for three weeks (a total of six sessions). The initial exercise session was composed of repeated extension of five times followed by one minute's, rest, extension of five times again followed by one minute's rest, and lastly extension of ten times (5/5/10). The five exercise sessions thereafter were composed of 5/15/20. No other treatment was added to this. A satisfactory to complete resolution of their low back pain was obtained in 12 (67%) patients.

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We investigated acupuncture treatment for low back pain at National Tsukuba College of Technology Clinic.
Subjects were the charts of 841 low back pain patients who had been treated with acupunture at our clinic from April, 1992 to March, 1994; 438 males and 403 females, ages ranged from 13 to 93 years with an average age of 48 years.
In the majority of cases, they were treated with low frequency electro-acupuncture (lHz for 15 min.) applied to the para-vertebral muscles.
Clinical diagnosis of subjects were primarily “common low back pain” (40 %), followed by osteoarthritis (10%), sciatica (6%), radiculopathy (5%), herniation (5%), osteoporosis (5%) etc.
Judging from the clinical descriptions in the charts, criteria for clinical responses to treatment was grouped into the following 5 grades; “markedly improved” (chief complaint disappeared), “moderately improved” (improvement of chief complaint continued to next session), “slightly improved” (description of improvement after acupuncture), “poor” and “worsened”
An effectiveness rate of more than 60% was seen in common low back pain (62.2%), sciatica (79.5%), herniation (74.2%) and osteoporosis (64.3%) when a response of “moderately improved” or better was regarded as successful . On the other hand effectiveness rates were lower for lumbar radiculopathy (51.1%) and osteoarthritis (51.6%), 40% for discopathy, 20% for psychogenic and 0% for myelopathy.
Although the aim of this project is to evaluate the efficacy of acupuncture, with respect to design and criteria for assessment this study is weak (e.g., retrospective study; no control group; no objective measures; no standardization of treatment; no quantitative analysis). However, the results suggest that acupuncture is effective not simply in common low back pain, but also in low back and lower extremity pain with neural deficit.

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