What is the clinical evidence from this study?

Study design: Observational. Population: Lumbar disc herniation with anxiety and depression (n=90). Intervention: Lever positioning manipulation (LPM) vs. Pre-treatment baseline and healthy controls. Primary outcome: Correlation between changes in Frontal_Inf_Orb_L functional connectivity and changes in Self-Rating Anxiety Scale (SAS) scores (r = 0.35, p=0.015).

What question did this study set out to answer?

Analyze brain network remodeling related to anxiety relief in lumbar disc herniation patients treated with lever positioning manipulation.

March 18, 2026Open Access

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

Key Result

Lever positioning manipulation reduced anxiety in lumbar disc herniation patients, with symptom relief positively correlating with functional connectivity changes in the Frontal_Inf_Orb_L (r=0.35).

Key Points

Analyze brain network remodeling related to anxiety relief in lumbar disc herniation patients treated with lever positioning manipulation.
Conducted resting-state fMRI on lumbar disc herniation patients before and after treatment.
Compared results with age- and gender-matched healthy controls.
Assessed negative emotions using clinical questionnaires.
Analyzed brain functional characteristics through amplitude of low-frequency fluctuation and regional homogeneity.
Performed correlation analyses on changes in brain connectivity and emotional scores.
Patients exhibited reduced mALFF values in specific brain regions related to negative emotions.
Post-treatment, mALFF values significantly increased in frontal and temporal regions, indicating improved brain function.
Significant connectivity differences observed between specific regions post-treatment.
Positive correlations found between changes in certain brain areas and anxiety scores.

Study Design

Type

Observational (n=90)

Multicenter

Structured PICO

Does lever positioning manipulation improve brain functional network remodeling and anxiety in patients with lumbar disc herniation?

Population

Adults aged 18 to 65 with lumbar disc herniation (LDH) and negative emotions (SAS > 50, SDS > 53)

Intervention

Lever positioning manipulation (LPM)

Comparator

Age- and gender-matched healthy controls receiving no LPM treatment

Outcome

Brain functional network remodeling (ALFF, ReHo, FC) and changes in negative emotions (SAS and SDS scores)surrogate

Lever positioning manipulation may alleviate anxiety in patients with lumbar disc herniation by remodeling the Ventral Attention Network-Default Mode Network.

Main Result

Effect estimate: r = 0.35

p-value: p=0.015

Limitations

Lack of an independent untreated LDH control group
Use of seed-based functional connectivity analysis instead of independent component analysis (ICA)
No repeated rs-fMRI measurements for the healthy control group
Extrapolating from ROI-level findings to large-scale networks should be interpreted cautiously
Anxiety-related alterations may partly overlap with pain-related neural processes

Abstract

To 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. A 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. Compared with the healthy control group, LDH patients with negative emotions showed a reduction in mALFF values in the FrontalSupMedialR and FrontalMidL, with no enhancement in any brain region. The szReHo values of the CingulumMidL 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 FrontalInfOrbL and TemporalInfR, while significantly decreased in the ParacentralLobuleL and CuneusL. The szReHo values significantly increased in the RectusR, TemporalInfR, and CingulumMidR, while significantly decreased in the CuneusR, PostcentralR, LingualR, and PostcentralL. ROI-wise analysis revealed significant connectivity differences between the FrontalInfOrbL and RectusR. Correlation analysis showed that the ∆ FrontalInfOrbL had a positive correlation with ∆ SAS (r = 0. 35, P = 0. 015 0. 05) and ∆ RectusR (|r| =0. 05 0. 05) with ∆ SDS. LDH 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. https: //clinicaltrials. gov/study/NCT05613179, identifer: NCT05613179, 14/11/2022, retrospectively registered. .

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