The diagnosis of double-crush lesion in the L5 lumbar nerve using diffusion tensor imaging

• Published in: The spine journal 2016-03, Vol.16 (3), p.315-321
• Main Authors: Kanamoto, Hirohito, MD, Eguchi, Yawara, MD, PhD, Suzuki, Munetaka, MD, PhD, Oikawa, Yasuhiro, MD, PhD, Yamanaka, Hajime, MD, PhD, Tamai, Hiroshi, MD, PhD, Kobayashi, Tatsuya, MD, PhD, Orita, Sumihisa, MD, PhD, Yamauchi, Kazuyo, MD, PhD, Suzuki, Miyako, MD, PhD, Aoki, Yasuchika, MD, PhD, Watanabe, Atsuya, MD, PhD, Takahashi, Kazuhisa, MD, PhD, Ohtori, Seiji, MD, PhD
• Format: Article
• Language: English
• Subjects: Aged; Aged, 80 and over; Anisotropy; Apparent diffusion coefficient; Case-Control Studies; Decompression, Surgical; Diffusion Tensor Imaging; Double-crush lesion; Female; Fractional anisotropy; Humans; Lumbar foraminal stenosis; Lumbar spinal stenosis; Lumbar Vertebrae; Magnetic Resonance Imaging; Male; Orthopedics; Prospective Studies; Radiculopathy - diagnostic imaging; Radiculopathy - surgery; Spinal Canal - diagnostic imaging; Spinal Nerves - diagnostic imaging; Spinal Nerves - injuries; Spinal Stenosis - diagnostic imaging; Spinal Stenosis - surgery
• ISSN: 1529-9430; 1878-1632
• DOI: 10.1016/j.spinee.2015.11.003

Abstract Background Context A double-crush lesion is a condition in which the lumbar nerve is compressed both medially and laterally in the spinal canal, where diagnosis can be very difficult, and is a factor leading to poor surgical success rates. Purpose Diffusion tensor imaging (DTI) was used to determine DTI parameter fractional anisotropy (FA) values and apparent diffusion coefficient (ADC) in both intraspinal column lesions alone and in double-crush lesions. Study Design This study used a prospective study. Patient Sample Of the 56 cases (mean age: 72.2 years) that underwent laminectomy for lumbar spinal stenosis at our clinic between April 2013 to March, 2015, 10 cases with L5 radiculopathy caused by L4–L5 stenosis (Intraspinal stenosis group (Group I); mean age: 74.7 years), and 5 cases with persistent symptoms caused by L5 foraminal stenosis despite L4–L5 decompression surgery (Double-crush group (Group D); mean age: 77.6 years) were targeted. One patient in Group D was diagnosed through microendoscopic intrapedicular partial pediculotomy and the remaining four cases by nerve root infiltration. Five healthy cases (mean age: 54 years) were studied as controls. Outcome measures Intraspinal zone (Iz), nerve root (N), and extraforaminal zone (Ez) were established as the regions of interest, and the L5 nerve FA and ADC values were determined on the affected side. Methods Diffusion tensor imaging was performed prospectively by 1.5T magnetic resonance imaging before surgery, and DTI parameters of L5 nerve were evaluated in all patients and healthy volunteers. Student t test was used for group comparisons, and a p