基于TBSS分析腰椎间盘突出所致慢性腰痛患者的脑白质结构改变OACSTPCD

Objective:To investigate the relationship between white matter abnormalities and clinical characteristics in patients with chronic low back pain due to lumbar disc herniation(LDH)by using tract based spatial statistics(TBSS).Methods:According to the occurrence of lumbar disc herniation,the subjects were divided into LDH patient group(LDH group,n=31)and healthy control group(HC group,n=31).And all underwent magnetic resonance diffusion tensor imaging(DTI)and high-resolution T1-weighted ima-ging.The fractional anisotropy(FA),mean diffusivity(MD),axial diffusivity(AD),and radial diffusivity(RD)of the brain regions with differences were calculated using TBSS analysis.The diffusion index values that differed between the two groups were then extrac-ted and analyzed by partial correlation with the clinical indexes(P＜0.05).Results:Compared with the HC group,in the LDH group FA values decreased in the middle cerebellar peduncle,corpus callosum,left corticospinal tract,bilateral medial lemniscus,bilateral in-ferior cerebellar peduncles,right superior cerebellar peduncle,bilateral cerebral peduncles,bilateral internal capsule,bilateral retrolen-ticular part of internal capsule,bilateral corona radiata,bilateral posterior thalamic radiations(include optic radiation),bilateral sagittal stratums,bilateral external capsule,bilateral cingulate gyrus,left fornix/stria terminalis and bilateral superior longitudinal fasciculus.RD values of the middle cerebellar peduncle,corpus callosum,bilateral medial lemniscus,bilateral inferior cerebellar peduncle,bilateral superior cerebellar peduncle,left cerebral peduncle,left posterior limb of internal capsule,left retrolenticular part of internal capsule,right anterior corona radiata,left superior corona radiata,bilateral cingulate gyrus and left fornix/stria termina in LDH group were higher than those in HC group.In LDH group,the increased MD and AD values of white matter skeleton were only confined to the middle cere-bellar peduncle.In the LDH group,FA and RD values of left fornix/stria terminalis region were positively correlated(r=0.446,P=0.012)and negatively correlated(r=-0.398,P=0.027)with disease duration,respectively.FA values of right retrolenticular part of internal capsule were positively correlated with Japanese Orthopaedic Association scores(JOA)(r=0.576,P=0.001).FA values of left medial lemniscus(r=0.406,P=0.023),and left inferior cerebellar peduncle region(r=0.405,P=0.024)were posi-tively correlated with Hamilton depression scale(HAMD)scores.Conclusion:Patients with LDH-induced chronic pain have extensive cerebral white matter microstructural damage,and white matter damage in the fornix/stria terminalis region is associated with the course of the disease.