Abstract
The purpose of this study was to evaluate the utility of diffusion tensor imaging (DTI) for guiding the treatment of lumbar disc herniation (LDH) by percutaneous transforaminal endoscopic discectomy (PTED). We collected the clinical data of a total of 19 patients: 10 with unilateral S1 nerve root injury, 6 with unilateral L5 nerve root injury, and 3 with unilateral L5 and S1 nerve root injury. All patients underwent DTI before surgery, 3 days post-surgery, 30 days post-surgery, and 90 days post-surgery. The comparison of the fractional anisotropy (FA) values of compressed lateral nerve roots before surgery and 3, 30, and 90 days post-surgery demonstrated the recovery of nerve roots to be a dynamic process. A significant difference was found in the FA values between compressed lateral nerve roots preoperatively and normal lateral nerve roots before surgery, 3 days post-surgery and 30 days post-surgery (p < 0.05). There was no significant difference in FA values between compressed lateral nerve roots and normal ones 90 days post-surgery (p > 0.05). DTI can be used for the accurate diagnosis of LDH, as well as for postoperative evaluation and prognosis, and it is thus useful for the selection of surgical timing.
Highlights
The purpose of this study was to evaluate the utility of diffusion tensor imaging (DTI) for guiding the treatment of lumbar disc herniation (LDH) by percutaneous transforaminal endoscopic discectomy (PTED)
DTI can detect the random movement of water molecules in nerve tissue, as well as measure their anisotropy, quantitatively analyze the diffusion of water molecules in nerve tissue with fractional anisotropy (FA) values, and evaluate the change of peripheral nerves[3,8]
Oswestry disability index (ODI) scores and symptom duration have been negatively correlated with FA value and positively correlated with apparent diffusion coefficient (ADC) value of compressed nerve roots in patients with LDH12. correlation analysis in this study did not found significant correlation between duration of symptoms and FA values
Summary
The purpose of this study was to evaluate the utility of diffusion tensor imaging (DTI) for guiding the treatment of lumbar disc herniation (LDH) by percutaneous transforaminal endoscopic discectomy (PTED). With the general aging of society, elderly patients with multiple systemic diseases and in poor physical condition who cannot tolerate open surgery have become highly frequent; precision has become increasingly important in minimally invasive treatments In this context, clinicians mainly rely on tools such as the Visual analogue scale (VAS), Japanese orthopaedic association scores (JOA), and Oswestry disability index (ODI), along with other indicators to evaluate surgical effects. Magnetic resonance diffusion tensor imaging (DTI) is a non-invasive method for tracing nerve fiber tracts and evaluating nerve injury It is a method for indirectly observing the change process of nerve tissue[3,4,5,6].
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