Objective Low back pain (LBP) is common, yet many individuals maintain normal activities of daily living despite chronic symptoms and structural changes evident on imaging. We hypothesized that functional resilience, defined as preserved functional capacity despite pain and age‑typical degenerative changes, represents a meaningful clinical phenotype, and that function‑centered outcome measures would better discriminate disability status than structural imaging features.
Methods This study analyzed 347 participants reporting LBP from the Wakayama Spine Study (N=866). Maintained function was defined a priori as Oswestry Disability Index (ODI) ≤20%. We compared those with maintained function (n=220, 63.4%) to those with impairment (n=127) across demographics, lifestyle, metabolic components, physical performance (grip strength, gait speed), and lumbar magnetic resonance imaging (MRI) findings. Multivariable logistic regression among participants with LBP, including age, sex, obesity, metabolic factors, pain intensity, physical performance, and MRI phenotypes, was used to identify independent predictors of functional resilience.
Results Functional resilience was common: 63.0% of LBP participants had ODI ≤20%. Resilient individuals were younger (65.0±11.9 years vs. 74.6±10.9 years, p<0.001) with superior physical performance. In multivariable models, male sex predicted maintained function (odds ratio [OR], 1.76; 95% confidence interval [CI], 1.03–3.00; p<0.05), while obesity (body mass index ≥25 kg/m2) was associated with reduced odds of resilience (OR, 0.50; 95% CI, 0.30–0.84; p<0.01). Standard MRI features, including disc degeneration, Modic changes, and Schmorl nodes, were not independently associated with functional status after adjustment, despite disc degeneration being highly prevalent even among resilient participants (95.4%).
Conclusion These data confirm that functional resilience is common in LBP and is not negated by the presence of structural MRI abnormalities. Among LBP patients, male sex and absence of obesity are independent predictors of maintained function, whereas standard MRI features do not independently predict functional status after age adjustment. Function-centered metrics (ODI, gait speed, grip strength) better discriminate functional status than structural imaging findings.
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From the Editor-in-Chief: Featured Articles in the April 2026 Issue Inbo Han Neurospine.2026; 23(2): 227. CrossRef
A Commentary on “Functional Resilience in Chronic Low Back Pain: Dissociating Magnetic Resonance Imaging Abnormalities From Real-World Disability in the Wakayama Spine Study” Shigeo Ueda Neurospine.2026; 23(2): 290. CrossRef
Objective Muscles are usually detached from C2 to facilitate C2 pedicle screw insertion. The aim of this study was to compare 1-year postoperative axial symptoms and limitations in activities of daily livings (ADLs) accompanying reduced neck mobility between 2 procedures in which all C2 muscle attachments are preserved: laminoplasty and C2 to T1 fusion (LPF group: n=15) and laminoplasty alone (LP group: n=26).
Methods We examined axial symptoms and limitations in ADLs using the Japanese Orthopedic Association Cervical Myelopathy Evaluation Questionnaire. We also examined related factors, including the occiput (O)–C7 angle in extension and flexion, and the rotational and O–C2 ranges of motion (ROM).
Results The postoperative decreases in the O–C7 angle in flexion (27.8° vs. 9.4°) and rotational ROM (40° vs. 15°), as well as the compensating postoperative increase in the O–C2 ROM (11.7° vs. 2.3°), were significantly greater in the LPF group. Most of the axial symptoms were similar between groups. The ability to perform ADLs tended to worsen more frequently in the LPF group, but the difference did not achieve significance.
Conclusion Postoperative changes in axial symptoms and loss of ROM were not obstacles affecting patients’ ability to perform ADLs after laminoplasty with muscle-sparing C2 to T1 fusion.
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Does perioperative ketorolac use impact union rate in spine surgery: a systematic review and meta-analysis Favour C. Ononogbu-Uche, Ramzy Ahmed, Ítalo Giarola, Lauren E. Corliss, Mostafa H. Algabri, Harry Wang, Kareem Akl, William Bohne, Norah Foster, Muhammad M. Abd-El-Barr The Spine Journal.2026; 26(5): 893. CrossRef
Changes in cervical sagittal parameters and the impact on axial symptoms after two types of posterior single-door cervical decompression surgeries Zehua Jiang, Xuanhao Fu, Wenjun Du, Rusen Zhu Journal of Clinical Neuroscience.2025; 137: 111293. CrossRef
Nationwide sample data analysis of additional surgery rate after anterior or posterior cervical spinal surgery Woon Tak Yuh, Minjung Kim, Yunhee Choi, Junghoon Han, Junhoe Kim, Taeshin Kim, Chun Kee Chung, Chang-Hyun Lee, Sung Bae Park, Kyoung-Tae Kim, John M. Rhee, Moon Soo Park, Chi Heon Kim Scientific Reports.2023;[Epub] CrossRef
Bridging the cervicothoracic junction during posterior cervical laminectomy and fusion for the treatment of multilevel cervical ossification of the posterior longitudinal ligament: a retrospective case series Dong-Zhao Wu, Zhen-Fang Gu, De-Jing Meng, Shu-Bing Hou, Liang Ren, Xian-Ze Sun BMC Musculoskeletal Disorders.2022;[Epub] CrossRef
Effects of Preservation of the Semispinalis Cervicis Inserted into C2 on Craniocervical Alignment After Laminoplasty Kiyoharu Shimizu, Takafumi Mitsuhara, Masaaki Takeda, Kaoru Kurisu, Satoshi Yamaguchi World Neurosurgery.2021; 146: e1367. CrossRef
Does the postoperative cervical lordosis angle affect the cervical rotational range of motion after cervicothoracic multilevel fusion? Christoph Scholz, Marc Hohenhaus, Ulrich Hubbe, Waseem Masalha, Yashar Naseri, Marie T. Krüger, Jan-Helge Klingler Clinical Biomechanics.2021; 90: 105484. CrossRef
Laminectomy and fusion in multilevel degenerative cervical myelopathy -How severely do patients feel restricted by a postoperatively reduced mobility of the cervical spine? Christoph Scholz, Jan-Helge Klingler, Waseem Masalha, Yashar Naseri, Marc Hohenhaus, Ulrich Hubbe Clinical Neurology and Neurosurgery.2020; 197: 106160. CrossRef
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