基于1H-MRS观察杠杆定位手法调控腰椎间盘突出症即刻脑代谢效应OA

Objective To analyze the effect of a single lever positioning manipulation(LPM)on the metabolites in the right precuneus(PCu)of patients with lumbar disc herniation(LDH)using hydrogen proton magnetic resonance spectroscopy(1H-MRS),and to explore the brain chemical basis for the immediate analgesic effect of LPM in the treatment of LDH.Methods From September 2023 to May 2024,34 patients who visited the Traction Department of the Third Affiliated Hospital of Zhejiang Chinese Medical University and met the inclusion criteria for LDH were selected.The patients were assigned to the LDH group(25 cases)and the healthy control group(HC group,25 cases)in matched gender and age.Patients in the LDH group underwent two 1H-MRS scans before and after LPM treatment,and Visual Analogue Scale(VAS)and Japanese Orthopaedic Association(JOA)scores were used to assess pain and lumbar dysfunction.Patients in the HC group received no intervention and no clinical scale assessment,and underwent 1H-MRS scans at the same time point as the LDH group before treatment.Based on the previous research results of our team,the peak coordinates of the right PCu were defined as the region of interest(ROI)to analyze the differences in metabolite ratios such as N-acetylaspartate/creatine(NAA/Cr),choline/creatine(Cho/Cr),and glutamate complex 1-6/creatine(Glx1-6/Cr)at the same time points between the two groups and before and after intervention in the LDH group.Correlation analyses were conducted with VAS and JOA scores.Results Compared with the HC group,the NAA/Cr and Cho/Cr values in the PCu brain region of the LDH group before treatment were significantly lower(P＜0.05).Compared with before treatment,the NAA/Cr value and JOA score in the LDH group after treatment significantly increased(P＜0.05);the Glx1/Cr,Glx2/Cr,Glx6/Cr values and VAS score significantly decreased(P＜0.05).The difference in NAA/Cr before and after treatment in the LDH group was negatively correlated with the difference in VAS and JOA scores(r=-0.404,P＜0.05;r=-0.440,P＜0.05),and the difference in Glx1 was negatively correlated with the difference in JOA scores(r=-0.504,P＜0.05).Conclusion LPM regulated the abnormal metabolic levels in the right PCu brain region of LDH patients,and NAA and Glx1 might be the key brain metabolic substances for the immediate analgesic effect of LPM in the treatment of LDH.(ClinicalTrials.gov No.NCT 05613179)