Discogenic low back pain has a certain prevalence, and its patho-mechanisms, diagnosis, and treatment have been discussed for some time. Sensory nerves, sensitizing cytokines, and instability have been suggested as pain mechanisms. Magnetic resonance imaging (MRI) is the gold standard for diagnosis, but various new MRI and positron emission tomography (PET) techniques have recently been developed. Nerve root blocks and intervertebral disc blocks are also used for diagnosis. Exercise therapy and drug therapy are the first-line treatment. Surgical treatment is also an option in refractory cases where the diagnosis is certain, but this remains a matter of debate. This paper describes these issues.

Although the pathogenesis of sacroiliac joint disorders is not clear, it is assumed that the pelvic intrinsic muscles (transversus abdominis and pelvic floor muscles) that functionally stabilize the sacroiliac joint, become less active than the pelvic extrinsic muscles, resulting in impaired functional stability, which make stress on the posterior sacroiliac ligament as a structural stability system. Symptoms include pain induced by movements or postures that place stress on the pelvic ring, pain induced when stress is applied to the pelvic ring, and tenderness of the posterior sacroiliac ligament. In our investigations, we have observed that the lower extremity positional perception during active straight leg raising is decreased, and that ankle dorsiflexion power is normal in the supine knee extension position, however it is weakened in the knee flexion position. When these symptoms are present, sacroiliac joint disorder is suspected, block injections into the posterior sacroiliac ligament are attempted, and if symptoms are relieved, even temporarily, a diagnosis of sacroiliac joint disorder is made. Various treatment modalities are used, but we find it useful to educate the patient the contraction pattern of the transversus abdominis muscle alone using ultrasound imaging, and to learn motor control in which the transversus abdominis muscle contracts prior to the pelvic extrinsic muscles before any movements.

Background: Chronic low back pain in athletes often involves Type 1 Modic changes and it is reported that one of the causes of Modic changes are mechanical stress from repeated spinal movement. However, there are no reports that analyzed specific spinale movements affecting the location where MRI signal changes occur. This study aims to analyze whether the signal change of Type 1 Modic changes in elite athletes will be associated with sports-specific spinal loading.

Methods: We first biomechanically analyzed the high-stress points during various spinal movements with a 3-dimensional lumbar spine finite element model. Clinically, patient charts with chronic low back pain and diagnosed with Type 1 Modic changes were reviewed, collecting data on age, sport type, Cobb angle, slippage distance on flexion lumbar X-rays and Short Tau Inversion Recovery Magnetic Resonance Imaging (STIR MRI) findings. Type 1 Modic change distribution was classified based on sagittal STIR MRI into "Anterior, " "Posterior, " "Right, " "Left, " and "Entire. "

Results: The finite element spine model showed higher stress on the bent side. Based on the Type 1 Modic distribution in athletes showed specific patterns: 5 intervertebral (29%) in the Anterior group, 6 (35%) in the Right group, and 2 (12%) in the Left group and 4 (24%) in the Entire group, no patients belonged to the Posterior group. All sports involved repetitive spinal movements strongly suspected of exerting stress on the Type 1 Modic-affected side.

Conclusion: The results were consistent with the hypothesis that specific movements during play affect the location of signal changes, leading to sports-specific laterality. However, sports movements are intricate, necessitating consideration of both the frequency of particular movements and the effects of other motions on stress.

Introduction: This study aimed to evaluate changes of lumbar Schmorl's nodes (SN) with Modic changes (MC) relating to low back pain.

Methods: This study included patients who underwent lumbar magnetic resonance imaging (MRI) between 2004 and 2020 (exam 1). Moreover, we extracted the patients with low back pain that was derived from SNs and/or MCs, excluding low back pain caused by myofascial, facet joint, bone, discogenic, and neurogenic (exam 2). These patients were followed for ≥2 years. We evaluated the findings of SNs and MCs on MRI.

Results: At the final follow-up (exam 1), there were 135 patients, and out of 321 SNs, 58 (18.0%) had decreased size, 164 (50.9%) had no change in size, 65 (20.2%) had increased size, 34 (10.6%) had newly appeared, and one (0.3%) had disappeared. There were significantly more SNs with MCs in decrease, increase, and new appearance (P<0.05), while significantly more without MCs in no change in size (P<0.001). At the final follow-up (exam 2), there were 27 patients, and out of 65 SNs, 14 (21.5%) had decreased size, 30 (46.2%) had no change in size, 16 (24.6%) had increased size, and five (7.7%) had newly appeared. There was a tendency to have more MCs in increased size SNs (MC+; 32.3%, MC−; 17.6%), and there were significantly more MCs in newly appeared SNs (MC+; 16.1%, MC−; 0%) (P<0.05). Furthermore, comparing SNs with MC type 1 and without MCs, there were significantly more former in increased size and newly appeared than the latter, showing 53.3% of the former and 17.6% of the latter in increase, and 26.7% of the former and 0% of the latter in newly appeared (P<0.05).

Conclusions: The size increase and new appearance of SNs are associated with the development of MCs, especially MC type 1, and may be related to a patient's condition in prolonging low back pain.

The innervations of trunk muscles differ from those of the upper and lower extremity muscles, and they are responsible for coordinated motor control function. Local muscles, located deep in the trunk, such as transversus abdominis and multifidus, are important for coordinating motor control. Muscle activity patterns are divided into the following 3 types: 1) early activity (feedforward activity); 2) tonic activity (sustained low activity); and 3) phasic activity (explosive activity). The local muscles mainly exhibit early activity and tonic activity during limb movement and serve as the basis for various movements. In contrast, pain causes dysfunction of the local muscles. Subsequently, dysfunction of the local muscles results in compensatory hyperactivation of the superficial muscles (global muscles) and increased facet and intervertebral joint stress. Therefore, it is important to perform optimal motor control exercises for local muscles from the acute phase. For athletes, gradual exercise therapy in advance to acquire optimal local muscle function to exert greater torque is important for preventing low back pain.

Exercise therapy for lumbar disorders is aimed at correcting and maintaining postures and activities that increase mechanical stress on the lumbar spine in daily life.

Exercise therapy based on the Pilates method involves the following: 1) exercising the upper and lower limbs with stabilization of the lumbar spine and pelvis to maintain the neutral position (physiological lumbar lordosis); and 2) enhancing thoracic spine mobility to reduce the mechanical stress on the lumbar spine. In other words, the maintenance of the neutral position (physiological lumbar lordosis) and increased spinal segmental mobility even in various life conditions are the goals of Pilates exercise.

Therefore, Pilates exercise can be effective not only for lumbago, but also as postoperative exercise for lumbar spine disorders. The clinical effects of Pilates exercise need to be investigated further.

The thoracic spine and thoracic cage are important in exercise therapy for spinal disorders. This paper describes the structure of the thorax, its joints, and the mobility of the spine. (1) A case of 5th lumbar spondylolysis in which respiratory motion affected spinal extension movement, and (2) a case of overhead sports (diving) are presented to show how dysfunction of the thoracic spine and thoracic cage affects spinal disease and its assessment, intervention methods and exercise therapy for the thoracic spine and thoracic cage. In addition, specific methods of assessment of thoracic spine and thoracic cage rotational mobility are introduced. Understanding the function of the thoracic spine and thoracic cage and integrating it into exercise therapy provides an effective approach to spinal disease.

The incidence of low back pain is high in the general population and among athletes. When assisting athletes whose low back pain makes it difficult for them to continue participating in sports and preventing recurrence, it is important to consider the impact of joints adjacent to the low back, rather than focusing only on the affected area of the low back, since sports require full-body movement. It is important to understand joint stability and mobility based on Joint by Joint theory when treating low back pain. Mobility is required in the thorax, which consists of the sternum, ribs, and thoracic vertebrae, and decreased mobility in the thorax can cause decreased stability in the lumbar spine, a factor that can influence the development of low back pain. Thoracic mobility is especially important for trunk extension and rotation. For athletes in whom thoracic mobility is thought to be related to the development of low back pain, assessment should identify decreased mobility, and exercises should be performed to improve function. On the other hand, thoracic mobility and movement patterns vary from person to person, making it difficult to define a normal range of motion. Therefore, it is necessary to evaluate and treat each athlete based on his or her athletic events and the movements that may have led to the onset of low back pain, and to consider which problems with thoracic spine mobility are associated with the onset of low back pain.

Osteoporotic vertebral fractures (OVF) are the most common osteoporotic fractures, affecting patients' quality of life and activity of daily life. Although orthotics is generally the treatment of choice for conservative treatment of OVF, the current evidence for orthotics is limited. Prospective studies without orthotics for the conservative treatment of OVF are difficult due to an ethical point of view because it is common sense that orthotics are the treatment of choice. In fact, there are very few reports that have verified the effectiveness of orthotics compared to no orthotics in the past. Therefore, we compared data from a cohort without orthotics and a cohort with orthotics using propensity score matching to demonstrate the effect of orthotics. In this review, we summarize the effects of orthotics in OVF based on reports of orthotics, including our previous study.

The effectiveness of Pilates as an exercise therapy for low back pain has been attracting attention, but it has not yet been fully verified in Japan. In November 2021, the Department of Orthopedics at Tokushima University, in collaboration with the University Hospital and five other hospitals and two universities in the prefecture, launched a project on the promotion and effectiveness of Pilates-based exercise therapy for low back pain.

Patients were either hospitalized at Tokushima University Hospital or were returnees who had undergone surgery in the past and had given their consent. Patients were either inpatients (6 days a week, 40-120 minutes a day, for 2-4 weeks) or outpatients (1-2 days a week, 40 minutes a time) at the collaborating hospital, and exercise therapy with Pilates was performed. Pilates aimed to improve the stability of the lumbar spine and the mobility of the thoracic spine and hip joint based on Joint-by-Joint theory. These exercise therapies were administered by physicians, physical therapists, and occupational therapists who were fully trained in Pilates instruction.

A 73-year-old woman with kyphosis and scoliosis complained of low back pain throughout the day. After 4 weeks of Pilates, the pain disappeared. In addition, her balance function improved, and her posture improved in standing, sitting, and walking.

In the future, we would like to increase the number of cases by utilizing the network with partner hospitals and verify the effectiveness of Pilates exercise therapy.

Introduction: This study aimed to analyze the difference in clinical outcomes of physical therapy for postpartum low back patients between puerperium and non-puerperium onset.

Subjects and Methods: A total of 18 postpartum low back pain patients participated in this study: 11 and 7 patients developed low back pain during the puerperium (< 2 months postpartum) and non-puerperium (≥ 2 months postpartum) periods, respectively. All patients underwent physical therapy for exercise and lifestyle guidance. Clinical outcomes were compared between the puerperium and non-puerperium onset groups at 0, 1, and 3 months after the start of physical therapy using the Visual Analogue Scale (VAS) for low back pain and the Oswestry Disability Index (ODI). Effect sizes were compared for the clinical outcomes with significant improvement.

Results: The VAS for low back pain and the ODI improved significantly from 1 to 3 months compared to the first assessment in both groups. Of the ODI sections, pain intensity, personal care, lifting, standing, and traveling sections improved significantly over 1 month, whereas all the sections except sex life improved significantly over 3 months in both groups. However, no significant differences were observed in clinical outcomes between the two groups. The highest effect size (>0.8) was for the pain intensity and standing sections in the puerperium onset group and, the pain intensity, personal care, and sitting sections in the non-puerperium onset group over 3 months.

Conclusion: Physical therapy improved clinical outcomes of puerperium onset, as well as during non-puerperium onset, cases in postpartum low back pain patients.

Introduction: Evaluating the risk of postoperative complications is essential for making decisions in patients with spinal metastases. Recent studies have shown that frailty is a predictor of surgical outcomes in cancer surgery and spinal surgery. However, the association of frailty with postoperative complications in spinal metastasis surgery remains controversial. Therefore, the aim of this study was to elucidate the risk factors for postoperative complications in spinal metastasis surgery with a focus on frailty.

Methods: A total of 241 patients with spinal metastases who underwent palliative surgery from 2015 to 2021 at our institution were enrolled. The Clavien-Dindo classification was used to assess postoperative complications with scores ≥ Grade II defined as complications. Data regarding demographics (age, sex, body mass index, and primary cancer) and preoperative clinical factors (new Katagiri score, Frankel grade, performance status, radiotherapy, chemotherapy, spinal instability neoplastic score, modified Frailty Index-11 (mFI), diabetes mellitus, and serum albumin levels) were collected. Univariable and multivariable analyses were performed to identify independent risk factors for postoperative complications (p < 0.05).

Results: In 47 of 241 (19.5%) patients, 57 postoperative complications were observed. The most common complications were wound infection/dehiscence, urinary tract infection, and pneumonia. On univariable analysis, male sex (p = 0.098), preoperative radiotherapy (p = 0.028), mFI (p < 0.001), Frankel classification (p = 0.051) and preoperative molecular targeted drugs (p = 0.030) were considered potential risk factors. The cut-off value of mFI was calculated to be 0.23 (sensitivity, 46.8%; specificity, 79.9%). On multivariate analysis, mFI ≥ 0.23 (odds ratio (OR), 2.82; 95% confidence interval (CI), 1.39-5.70; p = 0.003) and preoperative radiotherapy (OR, 2.11; 95% CI, 1.00-4.44; p = 0.049) were identified as significant risk factors. In particular, urinary tract infection (p = 0.012) and pneumonia (p = 0.037) were associated with mFI ≥ 0.23. Furthermore, the severity of postoperative complications was positively correlated with mFI (p < 0.001).

Conclusions: An mFI ≥ 0.23 and history of preoperative radiotherapy were associated with postoperative complications of spinal metastasis surgery.

Introduction: The aim of this study was to investigate the frequency of significantly effective cases, where pain almost disappeared, and the associated factors in condoliase therapy for lumbar disc herniation (LDH).

Methods: We enrolled 93 cases (61 males, 32 females, average age 45.6 years) that underwent condoliase therapy for LDH with minimally follow-up of 1 year. Clinical evaluations, including Oswestry Disability Index (ODI) and Visual Analog Scale (VAS) for back pain and leg pain, and imaging assessments using MRI were conducted before and 1 year after the treatment. Cases with leg pain VAS≤1 cm at 1 year were considered significantly effective and were compared with non-significantly effective cases. Additionally, multivariate analysis was performed to identify risk factors.

Results: Surgical treatment was subsequently required in 13 (14.0%) patients, and significantly effective in 49 (52.7%) patients. The rate of females and history of discectomy at the same level were significantly higher in non-significantly effective cases. Moreover, the symptom duration was significantly longer. Multivariate analysis identified symptom duration as independent associated factors.

Conclusions: Chemonucleolysis with condoliase was significantly effective in 52.7% of cases. Significant therapeutic effects can be expected in cases with shorter symptom duration.

Introduction: The incidence of postoperative delirium in spine surgery ranges from 12% to 24%. Whereas postoperative delirium is associated with longer hospital stays, increased medical costs, higher readmission rates, and higher mortality rates, there are few reports of risk factors and prevention methods for delirium in spine surgery. This study investigated the incidence and prognostic factors of delirium after kyphoplasty for osteoporotic vertebral fractures, and the effectiveness of our early mobilization program for delirium.

Methods: This retrospective study included 327 patients (241 women, 86 men; mean age, 80.0±7.4 years; range, 65-99 years) who underwent kyphoplasty for osteoporotic vertebral fractures between January 2018 and May 2023. The Kihoku Super Early Ambulation Program (K-SEAP) initiated in April 2021 is a program in which patients walk under supervision by a physical therapist three hours after surgery to prevent postoperative delirium and to facilitate early acquisition of activities of daily living (ADL). Data were compared between the groups using the chi-square test and the Mann-Whitney U test. Binary logistic regression analysis using the forward stepwise likelihood ratio method was used to investigate risk factors for delirium. Variables with P values < 0.05 on the univariate analyses were entered as independent variables into the regression analysis.

Results: Postoperative delirium occurred in 23 of 327 patients (7%). Compared with the non-delirium group, the delirium group included older patients (delirium vs. non-delirium group; 84.0 vs. 79.7 years), who were mostly male (52% vs. 24%), more often had weekend surgery (39 vs. 18%), had lower MMSE (16 vs. 24 points), and received K-SEAP less (21 vs. 45%) (P < 0.05). Delirium was significantly associated with K-SEAP (odds ratio (OR) 0.21, 95% confidence interval (CI) 0.06-0.74), male sex (OR 3.55, 95%CI 1.24-10.2) and MMSE (OR 0.83, 95%CI 0.76-0.90).

Conclusions: The incidence of delirium after kyphoplasty for elderly patients was 7%. K-SEAP was the strongest predictor to prevent postoperative delirium in patients undergoing kyphoplasty. Future studies are needed to assess the effectiveness of early mobilization on clinical outcomes, including costs, in elderly patients with osteoporotic vertebral fractures undergoing kyphoplasty.

Introduction: Locomotive syndrome (LS) is a condition of reduced mobility associated with locomotor disorders, and one of the most common causes is lumbar spinal stenosis (LSS). LS stage 3 is the most severe condition requiring treatment, but there are few reports of the effectiveness of surgery for LS stage 3 and factors related to improving LS stage. This study examined surgical outcomes, including locomotor functions, in patients with LS stage 3 preoperatively. Factors related to improving LS stage were also examined from multiple perspectives, including preoperative locomotor functions, frailty, sarcopenia, and nutritional indices.

Methods: Clinical data of 118 consecutive patients with LS stage 3 preoperatively who underwent surgery for LSS at our institute were prospectively collected. Whether the LS stage and motor function improved at 1 year postoperatively was examined, and the patients were further divided into two groups according to whether theire LS stage improved at 1 year postoperatively, and the preoperative factors that hinder LS stage improvement were evaluated by univariate and multivariate analyses.

Results: At one year postoperatively, JOABPEQ and locomotor functions such as trunk muscle strength and walking speed improved significantly, and 64 patients (54%) showed improvement in their LS stage. Multivariate analysis showed that the factors hindering LS improvement after LSS surgery were preoperative short one-leg standing time and slow gait speed (< 1 m/s), cauda equina type disability, and history of lumbar spine surgery.

Conclusion: Preoperative factors hindering LS improvement after LSS surgery, in patients with LS stage 3 preoperatively, were preoperative short one-leg standing time and slow gait speed (< 1 m/s), cauda equina type disability, and history of lumbar spine surgery.

Introduction: We have been performing transforaminal full-endoscopic discectomy (TF-FED) under local anesthesia for lumbar disc herniation (LDH). All patients undergo the surgery using the outside-in technique with foraminoplasty of the superior articular process. In general, the L5/S1 level is considered to be at high risk of exiting nerve root injury (ENRI) due to the anatomically narrow intervertebral foramen and the proximity of the L5 nerve root due to the iliac and sacral wings. However, the results of TF-FED in L5/S1 cases have not been fully reported. The purpose of this study was to report the results of TF-FED for L5/S1 LDH under local anesthesia and to compare them with those of L4/5 cases.

Methods: Between April 2021 and December 2022, 62 patients underwent TF-FED for LDH at the L4/5 level (39 cases) or the L5/S1 level (23 cases) at our institution and were available for 6-month follow-up. The following parameters were evaluated: age, sex, right and left localization of the LDH, puncture distance, operation time, perioperative complications, re-operation, visual analogue scale (VAS), JOA Back Pain Evaluation Questionnaire (JOABPEQ), and Oswestry Disability Index (ODI) pre-operatively and 6 months postoperatively to compare the clinical outcomes.

Results: The mean age of all 62 patients was 44.5±18.2 years, 41 (66.1%) were male, 30 (48.4%) were right-sided, the mean puncture distance was 7.3±0.5 cm, the mean operation time was 82.9±17.8 min and 5 (8.1%) had a history of surgery. There were no perioperative complications including exiting nerve root injury (ENRI). Postoperative VAS, JOABPEQ, and ODI all showed significant improvement.

In the comparison between the L4/5 and L5/S1 groups (L4/5 vs L5/S1), no differences were found in age, sex, operation time, or history of surgery. There were no significant differences between the two groups except for preoperative JOABPEQ (low back pain (34.1 vs 19.4 points, p= 0.03), lumbar function (43.5 vs 29.8 points, p= 0.04) ), and ODI (44.2% vs 58.4%, p= 0.03). There were no significant differences between the two groups in VAS, JOABPEQ, and ODI at 6 months postoperatively.

Conclusions: TF-FED for LDH of L5/S1 showed postoperative results that were as good as those of L4/5 when adequate foraminoplasty was performed.

Introduction: When diagnosing lumbar spondylolysis in children and adolescents, computed tomography (CT) is necessary to observe the form of spondylolysis and select a treatment strategy. However, from the perspective of radiation exposure, it is best to avoid CT as much as possible. Bone imaging Magnetic Resonance Imaging (MRI) is an imaging method that has recently been attracting attention, and it can produce images similar to CT images. In this study, Bone imaging MRI and CT of lumbar spondylolysis were compared, and the diagnostic rates of Bone imaging MRI were clarified.

Subjects and Methods: There were 97 children and adolescents with lumbar spondylolysis who visited our hospital for the first time between June 2022 and September 2023. Of these, 85 patients underwent simultaneous Bone imaging MRI and CT (180 locations). Canon 1.5-T MRI device was used, and the sequence name was 3DFE, M-Echo method. Using the CT findings as the standard, the sensitivity, specificity, positive predictive value and negative predictive value of Bone imaging MRI were calculated.

Results: Bone imaging MRI by 1.5-T MRI showed a sensitivity of 63.2% (74/117), specificity of 96.8% (61/63), positive predictive value of 93.5% (74/76), negative predictive value of 58.7% (61/104).

Conclusions: Bone imaging MRI by 1.5-T MRI has low sensitivity and high positive predictive value. By combining Bone imaging MRI and STIR imaging, it may be possible to avoid CT in selected cases.

Introduction: In patients with tibialis anterior (TA) muscle weakness due to lumbar spine degenerative disease, the muscle quality of the lower extremities was evaluated by magnetic resonance imaging (MRI) before surgery, and its relationship with recovery of TA muscle strength after surgery was investigated.

Methods: Twenty-five patients with tibialis anterior muscle weakness due to lumbar degenerative disease were included in the study. Preoperative MRI (STIR) of the lower extremities was performed to evaluate the presence or absence of high-intensity signal changes in the TA muscle.

In addition, manual muscle testing (MMT) of the TA muscle was performed preoperatively and 6 months postoperatively, and the relationship with the high-intensity signal changes in the TA muscle on MRI (STIR) was examined statistically.

Results: Eight of 25 patients (32%) had high-intensity signal changes in the TA muscles. On preoperative MMT evaluation, the high-intensity signal changes were observed in 14.3% (2/14 cases) of TA muscle strength 4, 16.7% (1/6 cases) of 3, and 100% of cases 2 or less (5/5 cases). Statistical analysis showed an association between high-intensity signal changes in the TA muscle and TA muscle strength recovery at 6 months postoperatively.

Conclusions: Preoperative high-intensity signal changes in the TA muscle on MRI (STIR) were associated with postoperative TA muscle recovery. These results suggest that evaluation of TA muscle quality by MRI (STIR) may be a predictor of postoperative muscle strength recovery.

Introduction: The purpose of this study was to clarify the relationships of sagittal spinal alignment parameters, physical function, low back pain, and leg pain in patients with lumbar canal stenosis (LCS) who exhibit a swayback (SB) posture with a negative sagittal vertical axis (SVA).

Methods: The study included 127 preoperative LCS patients capable of independent walking. The patients were categorized into three groups: SB group (SVA < 0 mm), good alignment group (0 mm ≤ SVA < 50 mm), and anterior trunk tilt group (SVA ≥ 50 mm). A comparative analysis was conducted of sagittal spine alignment parameters (SVA, TK, LL, SS, PT, PI), walking ability (10-m gait speed, timed-up-and-go test), postural sway in the standing position, low back pain, and leg pain.

Results: The LL was significantly higher in the SB group than in the other two groups, and though PT was significantly lower in the anterior trunk tilt group, there was no significant difference compared with the good alignment group. TK, SS, and PT showed no significant differences among the three groups. There were no significant differences between the SB group and the other two groups in walking ability, postural sway in the standing position, low back pain, and leg pain.

Conclusions: LCS with a negative SVA did not show compensatory mechanisms in the thoracic spine or pelvis for higher lumbar lordosis. Physical function, low back pain, and leg pain in the SB group were similar to those in the good alignment group.

Introduction: The fenestrated pedicle screw (FPS) has been reported to reduce reoperation rates and the risk of screw loosening in osteoporotic patients. On the other hand, cement leakage has been reported in some cases. The purpose of this study was to examine cement leakage with the FPS.

Subjects and Methods: A total of 42 cases with 168 FPSs between February 2022 and May 2023 were examined. The most common disease was osteoporotic vertebral fracture. The study items were age, sex, level of screw use, and presence of cement leakage. In terms of cement leakage, Type S was defined as leakage from the segmental vein, Type B as leakage from the basivertebral vein, and Type C as leakage from the cortical bone defect, based on previous reports.

Results: The mean age of the patients was 81.0 years, and 19 (45.2%) were male. Cement leaks were observed in 26 of 42 cases (61.9%) and 43 of 168 screws (25.6%). Of these, 37 were Type S, 1 Type B, 4 Type C, and 1 Type S+B. There were no cases of adverse events.

Conclusion: Cement leakage was observed in 25.6% of FPSs. To prevent cement leakage, it is important to check cement hardness and pressure during injection.

In some cases, cement leaks were observed under fluoroscopy, so frequent fluoroscopic confirmation is necessary.

Introduction: In this study, the clinical results and prognostic factors after chemonucleolysis with condoliase for lumbar disc herniation in patients over 70 years 70 years of age were investigated.

Methods: The study included 20 patients over 70 years of age who presented primarily for evaluation of leg pain and underwent chemonucleolysis with condoliase for lumbar disc herniation. Preoperative and postoperative low back pain, leg pain, Japanese Orthopaedic Association (JOA) scores, plain radiographs, magnetic resonance imaging, and computerized tomography were compared between patients who improved (improvement group) and those without improvement (non-improvement group).

Results: Leg pain improved in 30.0% of the patients (6 and 14 in the improvement and non-improvement groups, respectively), and seven cases (35.0%) underwent surgery within one year. In patients who did not undergo surgery, leg pain improved significantly after treatment. Comparing the effective and ineffective groups, Pfirrmann's grades were significantly higher in the effective group.

Conclusions: Chemonucleolysis with condoliase for lumbar disc herniation in elderly patients was found to be effective in patients with advanced discwas found to be effective in patients with advanced disc degeneration, although less effective than in younger patients. These results suggest that chemonucleolysis with condoliase may be a useful treatment with appropriate indications.

Introduction: This study aimed to evaluate whether gait ability before surgery and outpatient exercise therapy after surgery impacted the clinical results in patients with osteoporotic vertebral fractures (OVFs) treated with balloon kyphoplasty (BKP).

Methods: The patients with OVFs in our hospital were divided into two groups according to the need for preoperative gait support: gait support group, n=57; and non-gait support group, n=58. Secondly, those groups were divided into four groups according to postoperative outpatient exercise therapy: group A, n=24, support (−), exercise therapy (−); group B, n=33, support (−), exercise therapy (+); group C, n=26, support (+), exercise therapy (−); and group D, n=32, support (+), exercise therapy (+). The clinical results were compared among those groups 6, and 12 months after BKP using a visual analogue scale, Japanese Orthopaedic Association Back Pain Evaluation Questionnaire (JOABPEQ), and Short-Form 8-Item Health Survey.

Results: Gait support group had significantly older patients, longer hospitalized duration and more sagittal vertical axis than non-gait support group. The clinical evaluation methods improved after surgery in the all groups. However, non-gait support group showed higher scores and had higher efficacy rates for walking ability and social life function of JOABPEQ than gait support group 6 and 12 months after surgery. Moreover, group D showed higher scores for walking ability and social life function and had higher efficacy rate for walking ability than group C 6 months after surgery.

Conclusions: These results suggest that gait ability before surgery might affect the clinical results in OVF patients treated with BKP. In addition, outpatient exercise therapy might be effective for OVF patients treated with BKP who needed preoperative gait support.

Introduction: Changes in mid-distance gait using a lower limb skeletal muscle support system with elastic contraction for adult spinal deformity (ASD) patients were investigated.

Methods: ASD patients over 40 years of age who were admitted to our hospital for examination were included in the study. The patients'walking was analyzed over a medium distance with and without a lower limb supporter that assists walking by hooking an elastic supporter connected to a lumbar belt to the forefoot and heel on both sides of the body. Patient factors and gait parameters were compared between the group that walked at least 10% greater than the 6-minute walking distance when wearing the supporter and the group that did not.

Results: Thirty patients (25 women, mean age 71.6 years) were analyzed. The mean 6-minute walking distance was 300.5 m without the supporter and 306.1 m with the supporter (P=0.557). Seven of the 30 patients improved their 6-minute walking distance from an average of 203.6 m without the supporter to 280.0 m with the supporter. There were no significant differences in patient factors or X-ray parameters in the improved group compared to the unimproved group, but the 6-minute walking distance without the supporter was shorter (203.6 m vs. 330.0 m, P=0.009), and the angle of trunk forward tilt (maximum value) was greater (33.2° vs.15.3°, P=0.110).

Conclusion: A lower limb supporter using elastic contraction was effective in improving gait in ASD patients with more anterior trunk tilt during walking.

Introduction: Lumbar spondylolysis is known to be one of the most common lumbar disorders in developing athletes. Soccer is one of the most common sports in which lumbar spondylolysis occurs. In this study, the aim was to develop a screening tool for the early detection of lumbar spondylolysis in junior high school soccer players.

Methods: A questionnaire survey and lower extremity flexibility evaluation of 37 junior high school soccer players were conducted. Based on the questionnaire survey, the players were divided into two groups: those with a history of treatment for spondylolysis (lumbar spondylolysis group) and those who had never had low back pain (control group), and compared.

Results: Of the 9 lower extremity flexibility assessment items, hip extension range of motion was significantly different between the 2 groups, with 6 positive and 2 negative in the lumbar spondylolysis group and 2 positive and 27 negative in the control group (P = 0.0003). There were no significant differences in the other 8 items between the 2 groups.

Conclusions: In junior high school soccer players with a history of treatment for lumbar spondylolysis, the physical characteristics of hip extension range of motion were found to be inadequate compared with those who had never had low back pain. In addition, self-care instruction aimed at obtaining a hip extension range of motion of 15 degrees or more was considered important for preventing the onset and recurrence of lumbar spondylolysis.