Remodeling of the ventral attention network-default mode network as potential neural correlates of anxiety in lumbar disc herniation patients treated with lever positioning manipulation: a resting-state fMRI study.

objectiveTo analyze the brain functional network remodeling associated with the relief of negative emotions in patients with lumbar disc herniation (LDH) treated with lever positioning manipulation (LPM) using resting-state fMRI (rs-fMRI) technology.

methodsA prospective study included LDH patients (Group 1, n = 47) and age- and gender-matched healthy controls (Group 2, n = 43). Group 1 underwent brain functional MRI at two time points: before LPM (TP1) and after LPM (TP2). The healthy control group (Group 2) did not receive LPM treatment and underwent a single fMRI scan. Additionally, participants in Group 1 completed clinical questionnaires for negative emotions using the Self-Rating Anxiety Scale (SAS) and the Self-Rating Depression Scale (SDS), while Group 2 did not complete any clinical scales. The amplitude of low-frequency fluctuation (ALFF) and regional homogeneity (ReHo) were used to analyze brain functional characteristics, and specific brain regions were extracted as regions of interest (ROI) for functional connectivity (FC) analysis. Finally, correlation analyses were conducted between the changes (∆ values) in ROI functional connectivity and the changes (∆ values) in SAS and SDS scores.

resultsCompared with the healthy control group, LDH patients with negative emotions showed a reduction in mALFF values in the Frontal_Sup_Medial_R and Frontal_Mid_L, with no enhancement in any brain region. The szReHo values of the Cingulum_Mid_L also showed a specific reduction without enhancement in any brain region. ROI-wise analysis of these significantly different brain regions did not reveal significant differences in connectivity between ROIs. After LPM treatment, LDH patients showed significant relief in negative emotions and notable brain activation. Compared with pre-treatment (TP1), post-treatment (TP2) mALFF values significantly increased in the Frontal_Inf_Orb_L and Temporal_Inf_R, while significantly decreased in the Paracentral_Lobule_L and Cuneus_L. The szReHo values significantly increased in the Rectus_R, Temporal_Inf_R, and Cingulum_Mid_R, while significantly decreased in the Cuneus_R, Postcentral_R, Lingual_R, and Postcentral_L. ROI-wise analysis revealed significant connectivity differences between the Frontal_Inf_Orb_L and Rectus_R. Correlation analysis showed that the ∆ Frontal_Inf_Orb_L had a positive correlation with ∆ SAS (r = 0.35, P = 0.015 < 0.05), and the ∆ Rectus_R had a positive correlation with ∆ SAS (r = 0.33, P = 0.0247 < 0.05). No correlation was found between the ∆ Frontal_Inf_Orb_L (|r| =0.17 < 0.3, P = 0.2505 > 0.05) and ∆ Rectus_R (|r| =0.05 < 0.3, P = 0.7233 > 0.05) with ∆ SDS.

conclusionLDH patients with associated negative emotions exhibit altered functional connectivity in the Default Mode Network-Executive Control Network-Salience Network. The neural remodeling of the Ventral Attention Network-Default Mode Network may represent a potential neural correlate of anxiety in LDH patients treated with LPM. TRIAL REGISTRATION NUMBER: https://clinicaltrials.gov/study/NCT05613179 , identifer: NCT05613179, 14/11/2022, retrospectively registered..