KU Leuven Department of Rehabilitation Sciences, Leuven.
Biomedical Research Institute, Rehabilitation Sciences, Hasselt University, Diepenbeek, Belgium.
Clin J Pain. 2019 May;35(5):394-406. doi: 10.1097/AJP.0000000000000692.
Patients with nonspecific low back pain (NSLBP) rely more on the ankle compared with the lower back proprioception while standing, perform sit-to-stand-to-sit (STSTS) movements slower, and exhibit perceptual impairments at the lower back. However, no studies investigated whether these sensorimotor impairments relate to a reorganization of the primary and secondary somatosensory cortices (S1 and S2) and primary motor cortex (M1) during proprioceptive processing.
Proprioceptive stimuli were applied at the lower back and ankle muscles during functional magnetic resonance imaging in 15 patients with NSLBP and 13 controls. The location of the activation peaks during the processing of proprioception within S1, S2, and M1 were determined and compared between groups. Proprioceptive use during postural control was evaluated, the duration to perform 5 STSTS movements was recorded, and participants completed the Fremantle Back Awareness Questionnaire (FreBAQ) to assess back-specific body perception.
The activation peak during the processing of lower back proprioception in the right S2 was shifted laterally in the NSLBP group compared with the healthy group (P=0.007). Moreover, patients with NSLSP performed STSTS movements slower (P=0.018), and reported more perceptual impairments at the lower back (P<0.001). Finally, a significant correlation between a more lateral location of the activation peak during back proprioceptive processing and a more disturbed body perception was found across the total group (ρ=0.42, P=0.025).
The results suggest that patients with NSLBP show a reorganization of the higher-order processing of lower back proprioception, which could negatively affect spinal control and body perception.
非特异性下腰痛（NSLBP）患者在站立时比下背部本体感受更依赖于踝关节，完成坐-站-坐（STSTS）运动更慢，并且在下背部表现出感知障碍。然而，尚无研究调查这些感觉运动障碍是否与初级和次级体感皮层（S1 和 S2）和初级运动皮层（M1）在本体感受处理过程中的重新组织有关。
在 15 名 NSLBP 患者和 13 名对照组的功能磁共振成像期间，在下背部和踝关节肌肉上施加本体感受刺激。确定并比较了 S1、S2 和 M1 内本体感受处理过程中激活峰值的位置。评估了姿势控制过程中的本体感受使用情况，记录了完成 5 次 STSTS 运动所需的时间，并让参与者完成 Fremantle 背部感知问卷（FreBAQ）以评估背部特定的身体感知。
与健康组相比，NSLBP 组在右侧 S2 中处理下背部本体感受的激活峰值向外侧移位（P=0.007）。此外，NSLSP 患者完成 STSTS 运动更慢（P=0.018），并且报告了更多的下背部感知障碍（P<0.001）。最后，在整个组中发现，处理背部本体感受时激活峰值的更外侧位置与更受干扰的身体感知之间存在显著相关性（ρ=0.42，P=0.025）。
结果表明，NSLBP 患者表现出下背部本体感受的更高阶处理的重新组织，这可能会对脊柱控制和身体感知产生负面影响。
