A spinal manipulative therapy altered brain activity in patients with lumbar disc herniation: A resting-state functional magnetic resonance imaging study

Abstract

PurposeLumbar disc herniation (LDH) is one of the leading causes of low-back pain and results in a series of clinical symptoms, including pain, reflex loss, and muscle weakness. Spinal manipulative therapy (SMT) can relieve pain and promote internal and external stabilization of the lumbar spine. In this study, we investigated whether the brain alterations of LDH patients with SMT were frequency-dependent based on the calculation of Amplitude of Low-Frequency Fluctuations (ALFF) and fractional ALFF (fALFF). Further, we established a cohort of LDH patients to evaluate the contribution of SMT treatments to brain functional reorganization.MethodsA total of 55 participants, including 27 LDH patients and 28 health controls (HCs), were collected. All LDH patients underwent two fMRI scans (before SMT and after the sixth SMT session). To represent LDH-related brain oscillatory activities, we calculated the ALFF and fALFF in the conventional band (0.01–0.08 Hz), the slow-4 band (0.027–0.073 Hz), and the slow-5 band (0.01–0.027 Hz). Moreover, we extracted ALFF and fALFF values in clusters with significant differences to evaluate the SMT effect.ResultsCompared with HCs, the LDH patients before SMT (LDH-pre) exhibited increased fALFF in right lingual gyri in the conventional band, and showed increased fALFF in left Cerebelum_Crus1 in the slow-4 band. We further examined the abnormal brain activities changes before and after the SMT intervention. The ALFF and fALFF values of LDH-pre group were higher than those of the HCs and LDH-pos groups. After SMT, the increased ALFF and fALFF values were suppressed for patients in conventional band and slow-4 band.ConclusionThe present study characterized the altered regional patterns in spontaneous neural activity in patients with LDH. Meanwhile, SMT is an effective treatment of LDH, and we supposed that it might have been involved in modulating dysfunctional brain regions which are important for the processing of pain. The findings of the current study may provide new insights to understand pathological mechanism of LDH.

Effects of Cervical Spinal Manipulation on Saccadic Eye Movements

“…The authors observed a left hemispheric bias affecting the left precuneus, superior frontal, and postcentral posterior cingulate gyri asymmetrically [ 81 ]. Another similar study measuring the fMRI to measure the brain effects of lumbar spinal manipulation on individuals with chronic low back pain showed asymmetrical increases in hemispheric activity positively correlating to lower pain scores [ 82 ], while authors examining the brain effects of lumbar spine manipulation on individuals with disc herniation using fMRI found asymmetrical modulation of suspected dysfunctional brain regions essential for pain processing [ 83 ]. In a study examining the effects of spinal manipulation on the N30 somatosensory evoked potential, authors found a 31.3% decrease in the amplitude of the N30 potential within the prefrontal cortex after spinal manipulation, suggesting an alteration of somatosensory processing post-manipulation.…”

Lever positioning manipulation alters real-time brain activity in patients with lumbar disc herniation: An amplitude of low- frequency fluctuation and regional homogeneity study

“…As MRI is a sensitive imaging method, different intervention methods (Toffoletto et al, 2014), pathological states (Hauzeur et al, 1992), and measurement indicators (Takahashi and Grove, 2019) can activate different brain regions. For example, one study showed that conventional tuina therapy could activate the ALFF value of the right lingual gyri in LDH patients (Wen et al, 2022). Another study compared the brain regions of LDH patients with balance acupuncture and body acupuncture.…”

Traditional Chinese Manual Therapy (Tuina) reshape the function of default mode network in patients with lumbar disc herniation

“…The left fusiform dFC variance was lower in LDH patients than in HCs. The fusiform, a portion of the temporal and occipital lobes, is known to be engaged in several neuronal pathways that are involved in recognition (Jonas et al, 2015;Beelen et al, 2022), memory (Liu et al, 2021;Yan et al, 2022), and emotion (Liu et al, 2021;Yan et al, 2022), despite the fact that its role is not entirely understood. The orbital inferior frontal gyrus and the precuneus are both a member of the standard mode network.…”

“…Our previous research has shown that the lingual gyri and left cerebellum of LDH patients have abnormally high Crus1 ALFF and fractional ALFF (fALFF) in the slow-4 and conventional bands. By comparing the changes in abnormal brain activity before and after spinal manipulation, the increase of ALFF and fALFF in abnormal brain activity decreased to normal levels after Tuina ( Wen et al, 2022 ). In this study, we focused on the intensity of spontaneous activity in local brain regions but paid no attention to the coherence of spontaneous activity in local brain regions or the correlation between brain activities in different areas.…”