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

Characteristics of Individuals Maintaining Daily Function Despite Chronic Low Back Pain: Preliminary Data from the Healthy Spine with Pain Concept within The Wakayama Spine Study (#218)

Masatoshi Teraguchi 1 , Hiroshi Hashizume 1 , Marinko Rade 2 , Jeremy Fairbank 3 , Yuyu Ishimoto 1 , Keiji Nagata 1 , Noriko Yoshimura 4 , Munehito Yoshida 5 , Hiroshi Yamada 1
  1. Department of Orthopaedic Surgery, Wakayama Medical University., Wakayama City, WAKAYAMA, Japan
  2. Orthopedic and Rehabilitation Hospital Martin Horvat, Rovinj, Croatia
  3. Nuffield department of Orthopaedics, Rheumatology and Musculoskeletal Sceiences, University of Oxford, Oxford
  4. Department of Preventive Medicine for Locomotive Organ Disorders, 22nd Century Medical and Research Center, The University of Tokyo, , Bunkyo-ku, Tokyo, Japan
  5. Department of Orthopaedic Surgery, Sumiya Orthopaedic Hospital, Wakayama, Japan

Introduction

Low back pain (LBP) is one of the most common musculoskeletal conditions, traditionally viewed as a significant impediment to daily functioning. However, an intriguing phenomenon exists where some individuals maintain normal activities of daily living (ADL) despite experiencing chronic LBP, challenging conventional understanding of the relationship between pain and functional disability. This observation raises the possibility of redefining the concept of a "healthy spine" to encompass not just the absence of pain, but rather the maintenance of functional capacity despite the presence of pain. This study aimed to explore the characteristics of individuals who maintain normal ADL despite chronic LBP, potentially offering new insights into the definition of ‘healthy spine’.

Methods

We analyzed 348 participants (34.4%) with chronic LBP (>1 month duration) from the first Wakayama Spine Study (2008-2009), which included a total of 1,011 participants. ADL impairment was defined as an ODI score ≥20%. The study compared 220 participants (63.2%) without ADL impairment to 128 participants with impairment. Assessment included demographic characteristics, lifestyle factors, imaging findings (lumbar spinal stenosis, endplate defects, Modic changes, disc degeneration), and quality of life measures (SF-8, EQ-5D).

Results

Participants maintaining ADL were significantly younger (65.0 vs 74.8 years, p<0.0001) and more likely to consume moderate alcohol (32.7% vs 17.9%, p<0.005) compared to those with ADL impairment. Imaging findings revealed a lower prevalence of endplate defects (32.7% vs 46.1%, p<0.05) in the maintained ADL group. Quality of life measures were significantly better in the maintained ADL group, with higher scores in PCS (46.1 vs 38.5, p<0.0001), MCS (50.8 vs 48.9, p<0.05) of SF-8, and EQ-5D (0.88 vs 0.68, p<0.0001).

Conclusion

Our findings suggest that maintaining normal ADL despite chronic LBP is associated with younger age, moderate alcohol consumption, and fewer spinal degenerative changes, particularly endplate defects. These individuals also demonstrated superior quality of life measures across multiple domains. These results support the concept that a "healthy spine" might be better defined by functional capacity rather than the absence of pain, as demonstrated by the substantial proportion (63.2%) of chronic LBP patients who maintained normal ADL. This functional definition of spinal health could have important implications for clinical practice, suggesting that treatment strategies should focus not only on pain reduction but also on maintaining and improving functional capacity. Further research is needed to understand the mechanisms underlying this preserved functionality despite chronic pain, which could inform more effective therapeutic approaches and prevention strategies.