Diagnosis of Lumbar Foraminal Stenosis using Diffusion Tensor Imaging

Abstract

Diagnosis of lumbar foraminal stenosis remains difficult. Here, we report on a case in which bilateral lumbar foraminal stenosis was difficult to diagnose, and in which diffusion tensor imaging (DTI) was useful. The patient was a 52-year-old woman with low back pain and pain in both legs that was dominant on the right. Right lumbosacral nerve compression due to a massive uterine myoma was apparent, but the leg pain continued after a myomectomy was performed. No abnormalities were observed during nerve conduction studies. Computed tomography and magnetic resonance imaging indicated bilateral L5 lumbar foraminal stenosis. DTI imaging was done. The extraforaminal values were decreased and tractography was interrupted in the foraminal region. Bilateral L5 vertebral foraminal stenosis was treated by transforaminal lumbar interbody fusion and the pain in both legs disappeared. The case indicates the value of DTI for diagnosing vertebral foraminal stenosis.

Diffusion tensor imaging of radiculopathy in patients with lumbar disc herniation

“…DTI may reveal the local lumbar nerve damage. 38 There are several limitations to this study. First, only a few patients were investigated.…”

“…Recently we found that there were no abnormalities in either amplitude or nerve conduction velocity in the tibial or peroneal nerves in patients with L5 foraminal stenosis. 38 Nerve conduction studies are tests that are used to detect nerve conduction disorders peripheral to the knee, but lumbar nerve injuries are localised to the spinal canal, and if Waller degeneration does not extend to the region below the knee, then there is the possibility of falsenegative findings. The changes in DTI parameters indicating neuropathy were dependent on the site of nerve compression.…”

Recent advances in magnetic resonance neuroimaging of lumbar nerve to clinical applications: A review of clinical studies utilizing Dffusion Tensor Imaging and Diffusion-weighted magnetic resonance neurography

“…A total of 683 subjects were studied across 24 DTI articles. 177 patients with lumbar spinal canal stenosis (LSCS) in 5 articles 11,12,16,17,20) , 143 patients with lumbar disc herniation (LDH) in 7 articles 7,13,15,20,21,23,29) , 112 patients with lumbar radiculopathy in 3 articles 10,19,22) , 36 patients with foraminal stenosis (FS) in 6 articles 9,11,16,20,27,28) , 2 patients with lower back pain in one article 20) , 3 cases with diastematomyelia and one case with tethered cord in one article 30) , and one case with spina bifida in one article 26) were included. 7 post mortem subjects were investigated in one article 8) .…”

“…All 17 articles 7,[9][10][11][12][13][15][16][17]19,20,22,23,[27][28][29][30] . Except for one continued.…”

“…Except for one continued. article 7) (which showed low ADC), 9 articles [9][10][11]13,15,16,22,23,29) described high ADC in involved nerves and 5 articles demonstrated findings of ADC in healthy subjects 8,18,[24][25][26] . In an asymptomatic case, FA increased and ADC decreased following compression of the nerve root without injury 21) .…”