Department of Orthopedic Surgery, Sapporo Medical University School of Medicine, Sapporo, Hokkaido, Japan.
Spine (Phila Pa 1976). 2013 Jul 15;38(16):E998-1002. doi: 10.1097/BRS.0b013e31829862d3.
Prospective study based on magnetic resonance imaging for lumbar disc herniation.
In this study, we captured diffusion-weighted imaging (DWI) of dorsal root ganglion (DRG) of the affected nerve root in lumbar disc herniation and examined the relationship between apparent diffusion coefficient (ADC) and clinical symptoms to evaluate the efficacy of DWI in the diagnosis of lumbar spinal disorders.
DWI captures diffusion of water molecules in intracellular or extracellular fluid, allowing visualization of edematous changes, and is therefore used in diagnosis of hyper-acute cerebral infarction. In addition, it is possible to quantify the degree of diffusion using ADC calculated from the DWI data. Meanwhile in lumbar disc herniation, edematous changes occur in DRG of affected nerve root. If DWI enables visualization of these edematous changes, it will be possible to diagnose objectively the affected level.
The subjects were 30 patients who underwent surgery of unilateral radiculopathy and a single level lumbar disc herniation. We analyzed the relationship between morbidity duration, visual analogue scale (VAS) score of leg symptoms, and ADC. In addition, we investigated any correlation between VAS recovery ratio (i.e., VAS preoperative - VAS postoperative)/VAS preoperative × 100) with ADC.
When compared with the contralateral side, ADC of the affected DRG was observed to increase in 18 and decrease in 12 subjects, and thus no definite trend was observed. The relationship between morbidity duration, VAS score, and ADC had no observed correlation. A positive correlation between ADC and VAS recovery ratio was statistically observed (P < 0.01, leg pain: r = 0.707, leg numbness: r = 0.738).
This study showed that patients with decreased ADC tended to show poor improvement of leg symptoms, which may suggest the possibility that ADC of DRG is related to neuronal plasticity.
基于磁共振成像的腰椎间盘突出症前瞻性研究。
本研究对腰椎间盘突出症受累神经根背根神经节（DRG）进行弥散加权成像（DWI），观察表观弥散系数（ADC）与临床症状的关系，评估 DWI 对腰椎疾病的诊断价值。
DWI 可捕捉水分子在细胞内或细胞外液中的扩散，从而显示水肿变化，因此常用于超急性脑梗死的诊断。此外，还可以通过计算 DWI 数据得到的 ADC 来量化扩散程度。同时，在腰椎间盘突出症中，受累神经根的 DRG 会发生水肿变化。如果 DWI 能够显示这些水肿变化，则可以客观诊断受累水平。
本研究纳入 30 例单侧神经根病变和单节段腰椎间盘突出症患者，分析发病时间、下肢症状视觉模拟评分（VAS）与 ADC 的关系。此外，还研究了 VAS 恢复率（即术前 VAS-术后 VAS）/术前 VAS×100）与 ADC 的相关性。
与对侧相比，18 例患者的受累 DRG ADC 增加，12 例患者的 ADC 减少，无明显趋势。发病时间、VAS 评分与 ADC 之间无相关性。ADC 与 VAS 恢复率呈正相关（P < 0.01，下肢疼痛：r = 0.707，下肢麻木：r = 0.738）。
本研究表明，ADC 降低的患者下肢症状改善较差，这可能提示 DRG 的 ADC 与神经元可塑性有关。
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