Application of functional magnetic resonance imaging in identifying responsible brain regions associated with spinal diseases related pain

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Background: Spinal diseases related pain represents a critical clinical issue that demands urgent resolution. Current treatment and assessment strategies predominantly focus on peripheral mechanisms. The application of functional magnetic resonance imaging (fMRI) offers a promising approach to identifying potential central targets for intervention. Methods: We retrospectively included 31 patients with spinal diseases related pain and 32 controls with non-spinal, orthopedic complaints (no chronic neurological or psychiatric disorders). All participants underwent resting-state brain fMRI (eyes closed, awake). We quantified amplitude of low-frequency fluctuations (ALFF) with mean normalization (mALFF) and z-transformation (zALFF), regional homogeneity (ReHo; 27-voxel neighborhood), seed-based functional connectivity (FC; pre/postcentral seeds), and degree centrality (DC; binary and weighted). Between group tests used voxel-wise two-sample t_tests with Gaussian random field (GRF) correction. Results: Patient group was associated with increased m/zALFF in right cerebellar lobule IX and right Superior Frontal Gyrus, medial part, and lower activity in bilateral postcentral gyri and the cuneus, decreased m/zALFF in bilateral postcentral gyri. ReHo analysis confirmed reduced local synchrony in postcentral regions, spatially overlapping with ALFF findings. FC analyses revealed enhanced cerebellar-thalamic connectivity (Crus1/2, thalamus) but reduced connectivity in sensorimotor and higher-order cortical networks. DC showed hyperconnectivity in left cerebellar Crus I with reduced Superior Frontal Orbital (Frontal_Sup_Orb). All findings survived GRF correction at the pre_specified thresholds. Conclusion: Resting-state brain fMRI indicates a cerebello-thalamo-cortical alteration pattern in spinal diseases related pain featuring cerebellar involvement, prefrontal subspecialization, and multilevel sensorimotor disruption. These cross-sectional associations may inform hypothesis-generation for future neuromodulation studies and provide candidate biomarkers for monitoring, pending prospective validation.