• Yin Shi, Feng Zhao, Weiqiang Dou, Hongyuan Ding, Yuefen Zou, Yang Feng, Chuanbing Wang, Haibin Shi, and Yongxin Ren.
• The Department of Radiology, the First Affiliated Hospital of Nanjing Medical University, Nanjing, China.
• Spine. 2021 Jul 1; 46 (13): E734-E742.

Study DesignA prospective study.ObjectiveThe aim of this study was to investigate the relationship between diffusion tensor imaging (DTI) derived parameters of compressed nerve roots at subregions and the corresponding clinical symptoms to evaluate the patients with intraspinal lumbar disc herniation (LDH)-related lumbosacral radiculopathy pre- and postoperatively.Summary Of Background DataIt is crucial to explore whether magnetic resonanve imaging (MRI) can quantitatively evaluate intraspinal LDH-related lumbosacral radiculopathy before and after surgery.MethodsIn all, 66 patients underwent MRI scans and Clinical assessment before and after percutaneous transforaminal endoscopic discectomy (PTED). Pre- and postoperative findings of the related lumbar disk and nerve tractography were compared with two-way contingency table analysis. The embedded paired t test toolbox was applied to respectively compare the fractional anisotropy (FA) and apparent diffusion coefficient (ADC) values of nerves at the symptomatic and asymptomatic sides in three subregions pre- and postoperatively. The correlation of clinical Japanese Orthopedic Association (JOA) scores and FA/ADC values of nerves at three sub-regions was analyzed by stepwise multiple linear regression analysis.ResultsThe postoperative FA values were significantly higher than the corresponding preoperative values (P < 0.001), while comparable ADC values were found. Using tractography, a notable improvement of compressed nerve was revealed after surgery (61 cases, 92.4%). Additionally, multiple linear regression analysis identified significant associations between JOA scores and FA values of the compressed nerves with the greatest effect at the proximal region.ConclusionThe FA values at subarticular zone can reflect the microstructural changes of the corresponding compressed nerves and well associate with clinical symptoms. Therefore, the DTI parameter FA can be considered an effective tool in clinic to quantitatively evaluate intraspinal LDH-related lumbosacral radiculopathy before and after PTED surgery.Level of Evidence: 3.Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.

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