Abstract： Objective： To observe the effect of balance-adjusting acupuncture combined with pelvic reduction therapy on spinal-pelvic balance reconstruction and functional rehabilitation in patients with pelvic tilt-type nonspecific low back pain （NLBP）. Methods： A total of 94 patients with pelvic tilt-type NLBP admitted to Zhengzhou 460 Hospital from August 2023 to June 2025 were selected and randomly divided into the control group （47 cases） and the trial group （47 cases） by the random number table method. The control group received pelvic reduction therapy， and the trial group received balance-adjusting acupuncture combined with pelvic reduction therapy. The clinical effects， Visual Analogue Scale （VAS） score for pain， Japanese Orthopaedic Association （JOA） score， Oswestry Disability Index （ODI） score， spinal-pelvic imaging parameters [sagittal vertical axis （SVA）， sacral slope （SS）， pelvic incidence （PI）， pelvic tilt （PT）]， lumbar range of motion， and lower limb mechanical parameters were compared between the two groups before and after treatment. Adverse events during treatment were recorded. Results： After treatment，the total effective rate in the trial group was 95.74% （45/47），significantly higher than that of 78.72% （37/ 47） in the control group （P＜0.05）. After treatment， VAS and ODI scores were decreased in both groups when compared with those before treatment （P＜0.05）， while JOA scores were increased （P＜0.05）. The trial group had lower VAS and ODI scores and higher JOA scores than the control group （P＜0.05）. After treatment，SS，PT，and PI values were decreased in both groups when compared with those before treatment （P＜0.05）， but no significant differences were found between the two groups in SS，PT，or PI values （P＞0.05）. No significant change in the SVA values was observed within or between groups （P＞0.05）. After treatment，lumbar lateral flexion，forward flexion，and extension range of motion were increased in both groups when compared with those before treatment （P＜0.05），and the trial group showed greater improvement than the control group （P＜0.05）. After treatment， the stance phase and foot progression angle were increased in both groups （P＜0.05）， while the swing phase was decreased （P＜0.05）； however， no significant differences were found between the two groups in these gait parameters （P＞0.05）. During treatment， one case of needle sticking occurred in the trial group， and one case of mild subcutaneous hematoma occurred in the control group. Conclusion： Compared with pelvic reduction therapy alone， balance-adjusting acupuncture combined with pelvic reduction therapy can more effectively improve lumbar function， increase lumbar range of motion，and relieve pain in patients with pelvic tilt-type NLBP，with good safety.