الفهرس 
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Abstract
SUMMARY
Diffusion tensor imaging and tractography are new MR techniques that are recently used for visualization of lumbar spinal nerves, hence detection of their compression and affection by lumber disc prolapse. Diffusion tensor parameters; FA and ADC are considered indicators for nerve integrity because they are variably affected by the degree of root compression.
The aim of this work was to demonstrate the degree of radicular affection in patients with symptomatic posterolateral lumbar disc prolapse by measuring the mean values of radicular diffusion parameters through diffusion tensor imaging, to correlate such parameters with the clinical presentation and to visualize lumber nerves with tractography.
The study was conducted on 50 patients with unilateral posterolateral lumber disc prolapse, 31 male and 19 female patients, with a mean age 46.72 ±12.95 years.
The included patients were clinically assessed using Japanese orthopedic Association score (JOA) that covers the full spectrum of nerve root affection including: motor, sensory and bladder function. The degree of pain was assessed using visual analogue scale (VAS).
All patients included in our study were radiologically assessed using MRI lumbar spine with diffusion tensor imaging. DTI parameters; ADC and FA were measured for all patients included in the study along the compressed nerve roots and contralateral healthy roots.
The results of our study were summarized in the following:
The mean FA value for the compressed nerve root was significantly lower than that of contralateral healthy nerve root, and the mean ADC value of the affected nerve root was significantly higher than that of contralateral healthy nerve root.
Patients with disc extrusion had significantly lower mean FA values and higher mean ADC values than those with disc protrusion and those with disc bulge. Patients with disc protrusion had significantly lower mean FA and higher mean ADC values than those with disc bulge.
There was no statistically significant difference between VAS scores in patients with spondylosis, and those without spondylosis.
There was a statistically positive correlation between FA values of affected nerve and JOA scores. There was a statistically negative correlation between ADC values of affected nerve and the JOA scores.
There was a strong negative correlation between FA values of affected nerve and the VAS scores. There was a strong positive correlation between ADC values of affected nerve and the VAS scores.
CONCLUSION:
In patients with lumbar disc prolapse, radicular diffusion parameters are affected in the compressed roots in comparison to the healthy roots.
The affection of radicular diffusion parameters in patients with lumbar disc prolapse is correlated with the degree of prolapse.
The motor, sensory and bladder function and the degree of pain in patients with lumbar disc prolapse are correlated with radicular diffusion parameters.
Lumbar nerves could be visualized using tractography which revealed nerve changes in the form of indentation, displacement or disruption in the affected side.
RECOMMENDATIONS:
Confirmation and extension of these results in larger scale studies.
Comparison between patients with symptomatic versus asymptomatic lumbar disc prolapse in radicular diffusion tensor imaging parameters.
Further researches should be directed towards studying the effect of medical treatment, physiotherapy, interventional pain therapy and surgical intervention on radicular diffusion tensor imaging parameters in patients with lumbar disc prolapse.
Correlating DTI Parameters with MRS biomarkers in patients with lumbar disc prolapse.