Utility Of Diffusion Tensor Imaging For Guiding Thetreatment Of Lumbar Disc Herniation

Objective: The purpose of this study was to evaluate the utility of diffusion tensor imaging(DTI)for guiding the treatment of lumbar disc herniation(LDH).Methods: From December 2017 to October 2018,19 patients with lumbar disc herniation underwent percutaneous transforaminal nucleus pulpectomy,including 10 patients with unilateral S1 nerve root damage,6 patients with unilateral L5 nerve root damage,and 3 patients with unilateral L5 and S1 nerve root damage.19 patients were examined by DTI before operation,3 days after operation,30 days after operation and 90 days after operation,and the data were recorded.Each patient’s bilateral L5 and S1 nerve roots were measured for FA and ADC values and DTT three-dimensional reconstruction of nerve roots.Results: In the compressed nerve roots of patients,the comparison of FA values of the compressed nerve roots before operation,3 days after operation,30 days after operation and 90 days after operation shows that the recovery of nerve roots is a dynamic process.The FA value of the compressed nerve root was significantly different from that of the normal nerve root(P<0.05),indicating that the compressed nerve root was damaged.There was a significant difference in FA value between the compressed and normal nerve roots on the 3rd day after operation(P<0.05).It indicated that there might be edema reaction in the nerve roots on the 3rd day after operation,but it had partially recovered.The operation only created an environment for the recovery of nerve roots.There was a significant difference in FA values between the compressed and normal nerve roots 30 days after operation(P<0.05),indicating that nerve recovery was a slow process.There was no significant difference in FA value between compressed and normal nerve roots 90 days after operation(P>0.05),indicating that the nerve roots recovered to normal after operation.Three cases of lumbar intervertebral disc herniation with unilateral L5 and S1 nerve root injuries recovered well after operation,indicating that DTI can be used for accurate diagnosis of lumbar intervertebral disc herniation.Conclusion: We found that DTI can be used for accurate diagnosis,evaluation of postoperative effect and judgement of expected recovery effect of lumbar intervertebral disc herniation,and it has guiding significance for the choice of operative timing.