If patients keep lumbar spine forward flexion for a long time, back muscle may become fatigued and causes low back pain. Also if hyperextension of back is forced the capsule of the facets may be damaged and causes low back pain. Under these ideas, conservative treatments have been done for 35 years. Clinical study was performed on patients who visited again after Initial visit for low back pain. Among these patients, 71.8% were improved in two weeks and average interval to second visit was 4.9 years. Patients just keep good posture and have not accepted any treatment. Questionarie was sent to 800 residents whether they had low back pain in past. 681 (85.1%) returned. 85.1% in male and 86.0% in female had low back pain. Low back pain occurred when they held heavy things in 37.2% and kept forward flexion for a long time in 34.2% in male, and 40.8% in former and 46.8% in later in female. 78.4% in male were improved in two weeks and 85.7% in female. Low back pain has been prevent and improved by taking care of daily life posture.

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It has been reported that some risk factors smoking, deduced or limited physical activity, lumber disc degeneration, and trunk muscle weakness associated with higher incidences of low back pain. However, not enough research has been to determine which risk factor is the most predictive for developing low back pain. A five-year prospective study was conducted to determine the strength of association between these possible risk factors in asymptomatic subjects. Method; Our study group consisted of 63 volumteers (33 male and 30 female) who denied LBP at the time and who said that they had never suffered LBP. Sports activity was assessed according to the definition of Japan Welfare Ministry: 2 points-more than 30 min. of any kind of sport activities, more than twice a week and for more than one year; 1 point-irregularlyengaged in sports activities; 0 point-no sports activities. A smoking index was determined multiplying the number of cigarettes smoked by the number of years a person smoked. The degree of disc degeneration was assessed by sagittal MRI on a five-point scale applied to each disc level (L2/3, L3/4 and L5/S) according to Gibson (change in the signal from nucleus pulposus) and Tate (degree of disc protrusion). Trunk muscle strength was measured isokinetically (60 deg/sec) using Trunk Extension/ Flexion units. The ratio of peak torque in extension to flexion was calculated as E/F ratio. They were then followed prospectively for 5 years to determine the incidence of LBP and compared the correlation coefficient of each risk factor by multiple regression analysis. Result; The incidence of LBP during the 5 years was 39% in males and 63% in females. For men, the correlation coefficients were -0.40 for EiF ratio, -0.35 for body weight, 0.31 for the degree of disc protrusion, 0.19 for signal change of disc, -0.18 for height, 0.15 for smoking index, -0.08 for ports activity, and 0.04 for age. For women -0.46 for E/F ratio, 0.39 for the degree of disc protrusion, 0.28 for height, 0.26 for smoking index, 0.17 for body weight, 0.16 for signal change of disc, 0.13 for age, and 0.01 for sports activity. Stepwise regression analysis revealed that the E/F ratio was the most predictive risk factor in both male and female ceses. Conclusion; According to our study, the imbalance of trunk muscle strength, is the most critical risk factor in the development of LBP in both men and women.

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While great advances have been made in utilizing imaging technology in the diagnosis of low back pain disorders, there are still many patients who present with low back pain for whom a correct diagnosis has not been established. Since late in 1997 we have used Moony and Robertson's Pain Drawing System on patients to verify MRI findings. All patient are required to complete a pain drawing on their first visit to our clinic .The drawing can be done and assessed quickly. The clinician use the scoring sheet drawn up by Wiltse. Our analysis comparing both diagnostic techniques shows a remarkable degree of consistency in our evaluation of low back pain disorder. Utilizing either or both diagnostic methodologies should yield effective evaluations of various low back pain disorders.

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We sought to demonstrate a correlation of radiographic findings between the cervical and the lumbar spine based on analysis of 641 persons, 295 of who presented with complaints of low back pain. Significant correlation was observed between LBP and radiographic findings on both cervical and lumbar spine, especially in patients with intervertebral narrowing in their cervical and lumbar spine. 62, or 63% out of 98 people complained of low back pain, while in healthy group, 122 or 39% out of 310 people had similar complaints. The incidence of intervertebral narrowing on both cervical and lumbar spine increased consistently with age, and is higher in the presence of LBP in any age or gender group. This study's findings is suggestive that disc degeneration throughout the total length of the spine is a key observable risk factors in patients who present with LBP.

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During the lumbar traction, the authors used a rectangular (box-shaped) pillow under patient's thighs to bend the hips and the knees at 90 degrees of flexion, and compared the efficacy of this new position with relief achieved using a conventional triangular pillows. Forty patients who suffered from low back pain were divided into two groups based on the use of the two different pillows. Eighty percent of the patients in the group using the box-shaped pillow reported that the lumbar traction was effective in reducing low back pain, while only sixty-eight percent of patients in the group using conventional triangular pillows reported relief of low back pain.

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We seldom take an opportunity to treat a patient with arthritis of the sacroiliac joint, so it is difficult to diagnose it in early stage. we reported three cases of sacroiliitis: two cases of pyogenic arthritis and one of seronegative spondyloarthropathy due to Behcet disease. Two pyogenic cases were remissioned with intravenous injection of antibiotics, and in the case of Behcet disease, steroid was extremely effective among the treatment. Because of some different mechanisms of sacroiliitis, we tend to take a long time to make a diagnosis. Anyhow we should find out the cause of arthritis and take curative treatments as early as possible. And when you see a patient who complains severe pain on the buttock, you should take account of sacroiliac joint.

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Fusion of the lumbar spine is performed frequently, but indications are not always clearly defined. A retrospective review was completed on 24 parients who had either alumbar laminectomy and non instrumented or instrumented posterolateral fusion (PLF). Our study included 12 men and 12 women with a mean age of 55 years. They were divided into two subgruops: Group 1: 11 patients with degenerative spondylolisthesis (DO), and Group 2: 13 patients with degenerative stenosis (DS). The followup time was 0.7-5.5 years (3.9mean). A laminectomy and PLF in situ were performed in 16 patients (66.7%), laminectomy and PLF with transpedicular instrumented (PSF) was performed in 8 patients. At follow-up, solid fusion rate for PLF with PSF patients was 87.5%, and that for PLF in situ was 68.8%. There were no statistically significant difference in post-operative Japanese Orthopaedic Association back scores and recovery rates. Successful fusion did not influence patient outcome. Non-fusion was an indication for on going observation and concern. In this retrospective study, the majority of patients in both groups respond well to our surgical interventions.

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We performed segmental pedicle screw wire fixation (PSW) on 7 cases with lumbar spondylolysis. Previously, we experienced several problems dealing with biomechanical strength and long term external support associated with this surgical technique for spine fixation. In this current series, we sought to devise a new technique to address these problems. We report on 7 individuals using PSW, and two cases used our new surgical technique augmented with posterior instrumentation: rods with pedicle screws and wire fixation. Excellent results were obtained in all cases using our new surgical technique. Merit of our new technique is that segmental movement is temorarily stopped by strong fixation using pedicle screws and segmental movement is recovered after instrumentation and wire fixation is subsequently removed. Our method will be a viable option for spine surgeons to use when treating young patients with lumbar spondylolysis, especially when long term external support is not a reasonable possibility.

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Recently, we encountered two cases where low back pain was improved after vascular reconstructive surgery for arteriosclerosis obliterans in the abdominal cavity, and one additional case where low back pain was diagnosed as “ vascular back pain ” by physiologic and radiological examinations.Based on these three cases, we propose the term “ vascular backache ” and we discuss possible pathomechanisms underlying this condition.It is suggested that one factor leading to low back pain in some cases might be various degrees of ischemia of extensor muscles in the lumbar spine.

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We described an experience of a case of benign osteoblastoma of the fourth lumbar vertebra in a 21-year-old male which has been observed a year and resected totally following instrumentation with ISOLA. A plain X-ray showed a lytic and sclerotic lesion of the right transverse process of the fourth lumbar vertebra, CT and MR imaging clearly revealed a destructive lesion on the same part of the plain X-ray film findings. An open biopy was performed and obtained tissue was diagnosed as a benign osteoblastoma. We have been employed a continuous observation because his symptom was diminished after biopsy. However, one year later he complained a severe low back pain, and plain X-ray, CT, and MR imagings revealed an expanding lytic and sclerotic lesion of the right transverse process which invaded into spinal canal. The tumor was removed, and posterior fusion using ISOLA pedicle screw system and intersegmental wire fixation with bone grafting was accomplished. One year later the patient was free of symptoms. An osteoblastoma should be resected as soon as possible after diagnosed because of its rapidly growing character.

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A spinal block was performed on 11 patients with spinal compression fractures not associated with nerve injury. The drugs used were either 3 ml of 1% Mepivacaine hydrochloride or 1% Lidocaine containing 1.9-3.8 mg of Dexamethasone sodium phosphate, with the dosage decreased appropriately for elderly patients. Post block, patients were immobilized for three hours in a pelvis-down tilt position at about 45 degrees. One day following the block, a body cast was applied that fixed the spine but which allowed patients to ambulate. For evaluation of pain, the 5-point NRS score was used and the degree of improvement was assessed based on the patients' NRS score pre-and post-block. Pre-block pain scores averaging 4.8 showed a 65% improvement at 48 hours, post-block. All patients underwent an MRI, and no patients showed a burst fracture. The mean duration of a hospitalization for patients in this study was 12 days. Follow up examinations conducted at a mean of nine months post-injury showed a clear improvement in the low back pain. The only complication noted was slight headache in one patient. There were no serious complicaions. This treatment protocol deserves further attention as a fast and effective method of pain reduction in acute compression fracture.

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