gms | German Medical Science

65th Annual Meeting of the German Society of Neurosurgery (DGNC)

German Society of Neurosurgery (DGNC)

11 - 14 May 2014, Dresden

Structural brain alterations in patients with lumbar disc herniation

Meeting Abstract

  • Michael Luchtmann - Neurochirurgische Klinik, Otto-von-Guericke-Universität Magdeburg, Magdeburg
  • Yvonne Steinecke - Neurochirurgische Klinik, Otto-von-Guericke-Universität Magdeburg, Magdeburg
  • Jana Kohl - Neurochirurgische Klinik, Otto-von-Guericke-Universität Magdeburg, Magdeburg
  • Boris Jöllenbeck - Neurochirurgische Klinik, Otto-von-Guericke-Universität Magdeburg, Magdeburg
  • Raimund Firsching - Neurochirurgische Klinik, Otto-von-Guericke-Universität Magdeburg, Magdeburg

Deutsche Gesellschaft für Neurochirurgie. 65. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC). Dresden, 11.-14.05.2014. Düsseldorf: German Medical Science GMS Publishing House; 2014. DocP 147

doi: 10.3205/14dgnc542, urn:nbn:de:0183-14dgnc5428

Published: May 13, 2014

© 2014 Luchtmann et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.



Objective: Several studies compared surgical and nonoperative treatment of patients with herniated lumbar discs. Thus, surgical treatment tends to improve symptoms like pain and motor weakness faster and more efficiently than conservative management. The differences, however, were small and not statistically significant for most outcome parameters. Unfortunately, to date no factors have been identified that can predict which patients are likely to improve by a non-surgical management and which patients benefit from surgery.

Neuroimaging has significantly increased our understanding of pain perception and modulation. To date, no study has directly investigated morphometric changes of the brain associated with chronic pain due to lumbar disc herniation. We subsequently report alterations of the gray and white matter of the brain in patients suffering from LDH.

Method: The study comprised two groups: 12 patients with chronic low back pain were enrolled in the study. The individual duration of the back pain exceeded at least 3 month. All patients were diagnosed with isolated lumbar disc herniation either at the level L4-5 or L5-S1 using spinal MRI. The second group consisted of 12 age- and gender-matched subjects, which served as normal control group.

MR imaging was performed on a 3 Tesla Siemens Magnetom Trio scanner (Erlangen, Germany) using an 8-channel phased array head coil. A high-resolution anatomical dataset of the entire brain was acquired using a T1-weighted magnetization prepared rapid gradient echo (MPRAGE) sequence. MRI data was analyzed using the voxel-based morphometry toolbox implemented in SPM8 running under Matlab.

Results: LDH patients showed significantly reduced gray matter volume in the right anterolateral prefrontal cortex, the right temporal lobe, the left premotor cortex, the right caudate nucleus, and the right cerebellum as compared to healthy controls. Increased gray matter volume, by contrast, was found in the right dorsal anterior cingulate cortex, the left precuneal cortex, the left fusiform gyrus, and the right brainstem (see Figure 1 [Fig. 1]).

Conclusions: We conclude that the lumbar disc herniation can lead to specific local alterations of the gray and white matter in the human brain. The investigation of LDH-induced brain alterations could provide further insight into the underlying nature of the chronification processes and could possibly identify prognostic factors that may improve the conservative as well as the operative treatment of the LDH.