Brain Activity of Spinal Sagittal Imbalance Patients Based on Resting-state fMRI

Study Design: A cross-sectional study. Objective: This study aims to investigate brain abnormal regional homogeneity alterations in patients with SSI. Summary of Background Data: Recent research has demonstrated that patients with spinal sagittal imbalance (SSI) frequently experience gait disorders and postural instability. The brain is a crucial regulatory system that accomplishes controlled regulation of posture-gait synergy through complex mechanisms. However, investigations into the differences in brain function changes among patients with sagittal imbalance are lacking. Methods: Twenty SSI patients and 20 healthy controls matched for age, gender, and education level were enrolled. All participants underwent global spine x-ray and resting-state functional magnetic resonance imaging (rs-fMRI). Kendall coefficient of concordance was calculated for whole-brain analysis in each group. Two-sample t tests were performed to identify differences in brain regions between the two groups. In addition, we explored the relationship between clinical evaluations [sagittal vertical axis, Oswestry Disability Index (ODI), and regional homogeneity (ReHo) values] in brain regions. Results: Compared with healthy controls, the SSI group exhibited increased ReHo values in the following brain regions (all P < 0.01): Cerebellum Crus 1 Left [Cerebellum_Crus1_L (Anatomic Automatic Labeling: AAL)], Superior Temporal Gyrus Right [Temporal_Sup_R (AAL)], Superior Frontal Gyrus Medial Right [Frontal_Sup_Medial_R (AAL)], and Supplementary Motor Area Left [Supp_Motor_Area_L (AAL)]. Furthermore, our results revealed that the Cerebellum_Crus1_L (AAL) ReHo value was negatively correlated with ODI scores for sitting, lifting, walking, standing, and overall function, as well as the Physical Functioning (PF) score. Conversely, it showed a positive correlation with the Reported Health Transition (HT) score. The Temporal_Sup_R (AAL) ReHo value demonstrated negative correlations with ODI walk and General Health (GH) scores. The Frontal_Sup_Medial_R (AAL) ReHo value in the SSI group was negatively correlated with ODI walk but positively correlated with Mental Health (MH). Finally, the Supp_Motor_Area_L (AAL) ReHo value exhibited negative correlations with ODI scores for lifting, walking, sitting, standing, and overall function, as well as the PF score and sagittal vertical axis (SVA) measurement. However, it displayed positive correlations with Social Functioning (SF) and HT scores. Conclusions: These findings indicate significant alterations in ReHo within the Cerebellum_Crus1_L (AAL), Temporal_Sup_R (AAL), Frontal_Sup_Medial_R (AAL), and Supp_Motor_Area_L (AAL) regions in patients with SSI. The present study suggests that ReHo abnormalities could serve as a potential biomarker for further elucidating the neuropathological mechanisms, clinical diagnosis, and targeted treatment of patients with sagittal imbalance.