Luchtmann Michael, Steinecke Yvonne, Baecke Sebastian, Lützkendorf Ralf, Bernarding Johannes, Kohl Jana, Jöllenbeck Boris, Tempelmann Claus, Ragert Patrick, Firsching Raimund
Department of Neurosurgery, Faculty of Medicine, Otto von Guericke University Magdeburg, Magdeburg, Germany.
Institute of Biometry and Medical Informatics, Faculty of Medicine, Otto von Guericke University Magdeburg, Magdeburg, Germany.
PLoS One. 2014 Mar 3;9(3):e90816. doi: 10.1371/journal.pone.0090816. eCollection 2014.
Chronic pain is one of the most common health complaints in industrial nations. For example, chronic low back pain (cLBP) disables millions of people across the world and generates a tremendous economic burden. While previous studies provided evidence of widespread functional as well as structural brain alterations in chronic pain, little is known about cortical changes in patients suffering from lumbar disc herniation. We investigated morphometric alterations of the gray and white matter of the brain in patients suffering from LDH. The volumes of the gray and white matter of 12 LDH patients were determined in a prospective study and compared to the volumes of healthy controls to distinguish local differences. High-resolution MRI brain images of all participants were performed using a 3 Tesla MRI scanner. Voxel-based morphometry was used to investigate local differences in gray and white matter volume between patients suffering from LDH and healthy controls. LDH patients showed significantly reduced gray matter volume in the right anterolateral prefrontal cortex, the right temporal lobe, the left premotor cortex, the right caudate nucleus, and the right cerebellum as compared to healthy controls. Increased gray matter volume, however, was found in the right dorsal anterior cingulate cortex, the left precuneal cortex, the left fusiform gyrus, and the right brainstem. Additionally, small subcortical decreases of the white matter were found adjacent to the left prefrontal cortex, the right premotor cortex and in the anterior limb of the left internal capsule. We conclude that the lumbar disk herniation can lead to specific local alterations of the gray and white matter in the human brain. The investigation of LDH-induced brain alterations could provide further insight into the underlying nature of the chronification processes and could possibly identify prognostic factors that may improve the conservative as well as the operative treatment of the LDH.
慢性疼痛是工业化国家中最常见的健康问题之一。例如，慢性下腰痛（cLBP）使全球数百万人致残，并产生巨大的经济负担。虽然先前的研究提供了慢性疼痛中广泛的功能以及结构脑改变的证据，但对于腰椎间盘突出症患者的皮质变化知之甚少。我们研究了腰椎间盘突出症（LDH）患者脑灰质和白质的形态学改变。在一项前瞻性研究中确定了12名LDH患者的灰质和白质体积，并与健康对照组的体积进行比较以区分局部差异。所有参与者均使用3特斯拉MRI扫描仪进行高分辨率脑部MRI成像。基于体素的形态计量学用于研究LDH患者与健康对照组之间灰质和白质体积的局部差异。与健康对照组相比，LDH患者右侧前额叶前外侧皮质、右侧颞叶、左侧运动前皮质、右侧尾状核和右侧小脑的灰质体积显著减少。然而，在右侧背侧前扣带回皮质、左侧楔前皮质、左侧梭状回和右侧脑干中发现灰质体积增加。此外，在左侧前额叶皮质、右侧运动前皮质附近以及左侧内囊前肢发现白质有小的皮质下减少。我们得出结论，腰椎间盘突出症可导致人脑灰质和白质的特定局部改变。对LDH引起的脑改变的研究可以进一步深入了解慢性化过程的潜在本质，并可能识别出可以改善LDH保守治疗以及手术治疗的预后因素。
