• Tyler Scullen, James Milburn, Kevin Aria, Mansour Mathkour, R Shane Tubbs, and James Kalyvas.
• Department of Neurological Surgery, Ochsner Clinic Foundation, 1514 Jefferson Hwy, Jefferson, LA, 70112, USA. tylerscullen@gmail.com.
• Eur Spine J. 2024 Jul 16.

Study DesignWe reviewed the available literature systematically without meta-analysis following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.ObjectiveTo evaluate contemporary literature on use of spinal diffusion tensor imaging(sDTI) in spinal pathology.BackgroundsDTI reveals the location and functional state of critical long tracts and is a potentially useful adjunct in disease management.MethodsStudies were included if they presented or discussed data from investigative or therapeutic procedures involving sDTI on human subjects in the setting of surgically amenable spinal pathology. Studies were excluded if they were (1) restricted to computational models investigating parameters using data not obtained clinically, (2) about cranial DTI methods, (3) about spinal pathology data not related to surgical management, (4) discussions or overviews of methods/techniques with minimal inclusion of objective experimental or clinical data.ResultsDegenerative pathologies of interest were restricted to either cervical myelopathy (22/29,75.9%) or lumbar spondylosis 7/29,24.1%). Mass-occupying lesions included intradural pathology and discussed preoperative (7/9,77.8%) and intraoperative imaging(2/9,22.2%) as an adjunct to surgery 22.2%. Traumatic pathology focused on spinal cord injury prognosis and severity grading.ConclusionssDTI seems useful in surgical decision making and outcome measurements and in establishing clinical prognoses over a wide range of surgical pathologies. Further research is warranted with longer follow-up and larger population sizes in a prospective and controlled protocol.© 2024. The Author(s).

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