Oral Presentation 51st International Society for the Study of the Lumbar Spine Annual Meeting 2025

"Koshimagari Exercise” for Adult Spinal Deformity: A Prospective Multicenter Analysis of Optimal Patient Identification for Home-Based Exercise Using a Novel Classification (113817)

Hiroshi Taniwaki 1 , Shinji Takahashi 1 , Masatoshi Hoshino 2 , Koji Tamai 1 , Toshimitsu Ohmine 3 , Tamotsu Nakatuchi 4 , Goya Shinbashi 4 , Masatoshi Teraguchi 5 , Masakazu Minetama 6 , Kei Watanabe 7 , Naritoshi Sato 8 , Takuya Kitamura 9 , masaru kanda 8 , Tadao Tsujio 10 , Yuichi Takeuchi 10 , Tatsuki Mizouchi 11 , Katsuhito Ishizu 12 , Toshihito Ebina 13 , Yasunari Muraoka 13 , Tomonori Sodeyama 14 , Hiroshi　 Mikami 14 , Yuji Kasukawa 15 , Takahiko Hyakumachi 16 , Kazuhiro Ishida 16 , Kazufumi Miyagishima 16 , Yosuke Oishi 17 , Kiyonori Yo 18 , Ryota Kimura 15 , Hiromichi Sato 19 , Keiji Nagata 5 , Yu Yamato 20 , Ko Matsudaira 21 , Naohisa Miyakoshi 15 , Yukihiro Matsuyama 20 , Hirotaka Haro 22 , Hiroshi Hashizume 5 , Hiroshi Yamada 5 , Takashi Kaito 23 , Hidetomi Terai 1
  1. Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan
  2. Osaka Saiseikai Nakatsu Hospital, Osaka
  3. Shimada Hospital, Osaka
  4. Tsuji-Geka Rehabilitation Hospital, Osaka
  5. Wakayama Medical University, Wakayama
  6. Spine Care Center, Wakayama Medical University Kihoku Hospital, Wakayama
  7. Niigata Spine Surgery Center, Kameda Daiichi Hospital, Niigata
  8. Niigata University of Health and Welfare, Niigata
  9. Niigata University of Rehabilitation, Niigata
  10. Shiraniwa Hospital, Nara
  11. Spine Center,Niigata Central Hospital, Niigata
  12. Niigata Central Hospital, Niigata
  13. Kakunodate General Hospital, Senboku
  14. Funabashi Orthopaedic Hospital, Spine and Spinal Cord Center, Chiba
  15. Akita University Graduate School of Medicine, Akita
  16. Wajokai Eniwa Hospital, Hokkaido
  17. Hamawaki Orthopaedic Hospital, Hiroshima
  18. Hamawaki Orthopaedic Clinic, Hiroshima
  19. Akita Kousei Medical Center, Akita
  20. Hamamatsu University School of Medicine, Hamamatsu
  21. Tailor Made Back pain Clinic（TMBC）, Tokyo
  22. University of Yamanashi School of Medicine, Chuo
  23. Osaka Rosai Hospital, Osaka

Purpose: The prevalence of adult spinal deformity (ASD) is expected to exceed 60 million by 2050 due to an aging population and increased life expectancy. Despite advances in surgery, high complication rates and the economic burden highlight the need for effective non-surgical treatments. This study assesses the "Koshimagari Exercise," a self-exercise program for ASD patients, and aims to develop a classification system to identify those who would benefit most.

Methods: A prospective cohort study was conducted across 13 facilities, enrolling 144 participants from December 2020 to June 2022. The inclusion criteria were adults aged 50–80 years with chronic low back pain (LBP) due to spinal deformities. Participants attended weekly physiotherapist-led exercise sessions and performed self-exercises at home three times a week, focusing on flexibility, functional improvement, trunk and back muscle strengthening, motor learning, and pain control. The primary outcome was the change in the Oswestry Disability Index (ODI) from baseline to 6 months post-intervention, with a 12-month follow-up. Clinical evaluations included Health-Related Quality of Life (HRQOL) assessments with ODI and EuroQol-5 Dimensions (EQ-5D), spinal alignment radiography, and magnetic resonance imaging (MRI) of the paravertebral muscle (PVM) cross-sectional area.

Results: Of the 130 participants who provided written informed consent, 98 completed the 6-month follow-up. The study found that 42% of patients achieved a minimum clinically important difference (MCID) in ODI, with significant improvements in EQ-5D scores and LBP from baseline. Patients who achieved MCID had lower baseline body mass index and EQ-5D scores, and higher baseline ODI scores compared to those who did not. Logistic regression identified three significant predictors of MCID achievement: L4/S1 angle, the difference between standing and supine thoracolumbar kyphosis (ΔTLK), and the relative cross-sectional area (rCSA) of the PVM at L4/5. Based on these findings, a classification system was developed, dividing patients into Self-Exercise-Friendly and Self-Exercise-Limited groups, with a significant difference in ODI improvement observed between these groups at 6 months post-intervention.

Conclusion: The "Koshimagari Exercise,” a novel self-exercise program for ASD, achieved an MCID in the ODI for 42% of patients. The classification system, based on L4/S1 angle, ΔTLK, and L4/5 rCSA, identifies ideal candidates for this program, who can expect significant improvements in HRQOL.

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