New methods for diagnosing lumbar foraminal stenosis using dynamic digital tomosynthesis radiculography

Area of Science:

• Radiology
• Orthopedics
• Neurosurgery

Background:

• Lumbar radiculopathy symptoms, especially from foraminal stenosis, worsen when upright.
• Conventional MRI struggles to detect upright nerve root compression.
• Dynamic digital tomosynthesis radiculography (DTRG) offers a potential solution.

Purpose of the Study:

• To analyze lumbar nerve root compression using DTRG in patients with lumbar radiculopathy.
• To correlate leg pain with nerve compression in prone and upright positions.
• To evaluate DTRG's diagnostic utility for lumbar foraminal stenosis.

Main Methods:

• 30 patients with unilateral leg pain diagnosed with lumbar radiculopathy were evaluated.
• Patients were grouped into foraminal stenosis (17) and canal stenosis (13) based on MRI.
• Dynamic digital tomosynthesis radiculography (DTRG) measured nerve root diameter in prone and upright positions.
• Pain was assessed using a 100-point visual analogue scale (VAS).

Main Results:

• Upright leg pain (VAS) was significantly higher in the foraminal stenosis group (58 ± 24.7) vs. canal stenosis group (19.6 ± 13.2).
• Nerve root diameter was significantly smaller in the foraminal stenosis group (1.2 ± 0.2 mm) vs. canal stenosis group (0.2 ± 0.1 mm).
• DTRG demonstrated nerve compression in the upright position, linking foraminal stenosis to clinical symptoms.

Conclusions:

• DTRG can visualize upright nerve compression, highlighting the clinical relevance of foraminal stenosis.
• DTRG is a useful diagnostic tool for lumbar foraminal stenosis.
• This imaging modality aids in understanding the relationship between nerve compression and leg pain in different positions.