Abstract
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.
Highlights
Chronic low back pain disables millions of people across the world and generates a tremendous economic burden
Using voxel-based morphometry [32] our study showed significant local differences in gray and white matter volume between patients suffering from chronic low back pain and sciatica due to lumbar disc herniation (LDH) as compared to healthy controls
The findings can be divided into three main groups: (1) areas with decreased gray matter in LDH patients compared to healthy control group such as the right caudate nucleus and parts of the right cerebellum; (2) areas showing increased gray matter volume mainly involving the right dorsal anterior cingulate cortex, the left lateral precuneal region and the brainstem, and (3) regions that show decreased white matter volume such as in the anterior limb of the left internal capsule
Summary
Chronic low back pain (cLBP) disables millions of people across the world and generates a tremendous economic burden. Previous studies compared the efficiency of non-surgical management and surgical treatment of LDH [11,12,13,14,15]. Surgical treatment tends to improve symptoms like pain and motor weakness more efficiently than conservative management. The differences, were small and not always statistically significant for the outcome and surgery did not improve the return-to-work rate as compared to non-surgical treatment. In a very recent study El Barzouhi et al [16] revealed that the MRI assessment of disk herniation one year after the treatment did not distinguish between patients with a favorable outcome and those with an unfavorable outcome. Until now no factors were identified that can predict which patients are likely to improve by a non-surgical management and which should better be treated with surgery [17,18,19]
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