| BackgroundLumbar disc herniation(LDH)is caused by rupture of the disc fibrous ring for some reasons,and the nucleus pulposus protrudes or prolapses into the posterior spinal canal,causing the corresponding nerve root to be stimulated or compressed,and a series of corresponding clinical symptoms appear,more in the male prime of life.The pain caused by lumbar disc herniation is divided into acute pain and chronic pain according to the onset time.Chronic pain is different from acute pain,it has a long duration(?3 months),a complicated mechanism and poor conservative treatment effect.In recent years,with the change of people's living and working styles,the incidence of LDH has increased significantly.However,due to patients' insufficient understanding of surgery,the best treatment is often delayed,and the long-term lower back and lower limb pain seriously damages people's physical and mental health.Chronic low back pain is also one of the main causes of disability in the world,bringing a heavy burden on society and individuals.Persistent pain can cause mental and physical effects such as negative emotions,cognitive and behavioral disorders,and seriously affect the quality of life and level of patients.In recent years,the emergence of functional magnetic resonance has provided accurate localization for changes in brain function in chronic pain states and has become an important tool for neuroimaging research.At present,although there have been some studies on brain function changes in patients with chronic low back pain caused by LDH at home and abroad,its mechanism is complex and its effect on the brain remains unclear.ObjectiveThis article applies the regional homogeneity(ReHo)and voxel-mirrored homotopicconnectivity(VMHC)methods to study the changes of brain function in patients with chronic low back pain caused by LDH,and to analyze the correlation with the disease course,pain degree and depression score.Methods1.Selected 59 patients with chronic low back pain due to LDH as the case group from January 2017 to April 2018,who were admitted to the outpatient department of LDH in our hospital and failed to receive regular conservative treatment and the pain lasted longer than3 months.In addition,50 healthy volunteers with age and gender matching were included as the health control group(HC).All subjects underwent routine magnetic resonance imaging and functional brain imaging.Resting state functional magnetic resonance data processing assistant DPARSF4.3(http://www.restfmri.net)based on matlab2011 a was used for data preprocessing and ReHo calculation.The differences of ReHo between the two groups were analyzed,and their correlation with the course of disease,degree of pain and depression was analyzed.2.During the same period,67 patients with LDH chronic low back pain and 54 health controls were selected(the selection conditions were the same as above).VMHC was used as an indicator to analyze the functional connection between the two cerebral hemispheres of the case group,and the correlation analysis was conducted with the course of disease,pain degree and depression mood.Results1.Compared with the control group,the brain regions with increased ReHo in the LDH group were: left parhippocampus,bilateral orbital superior frontal gyrus,right orbital inferior frontal gyrus,right triangle inferior frontal gyrus,left precuneus and right middle cingulate gyrus.The brain areas decreased by ReHo include the right fusiform gyrus,the left calcarine and the left cuneus(P<0.05,GRF corrected).The increase in the ReHo value of the right orbital inferior frontal gyrus in the LDH group was positively correlated with the disease duration(r = 0.444,P = 0.001),while the increase of ReHo value in the leftorbital superior frontal gyrus was negatively correlated with SDS score(r =-0.460,P =0.001).2.Compared with the control group,patients in the LDH group had decreased VMHC values in the bilateral caudate nucleus and middle frontal gyrus,and no brain regions with increased VMHC values were found(P < 0.05,GRF corrected).VMHC value of caudate nucleus was negatively correlated with Self-rating depression scale(SDS)score(r =-0.383,P = 0.007).ConclusionIn LDH patients with chronic low back pain,there are abnormal activities in multiple brain regions in the resting state,which may impair the cognitive flexibility of LDH patients,and may also lead to the reduction of cognitive regulation efficiency of negative emotions. |
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