Ning Fan,1,* Tusheng Li,1,* Xuanyu Lu,1,* Xinyu Ma,2 Lihui Yang,1 Peng Du,1 Lei Zang,1 Shuo Yuan1 

1Department of Orthopedics, Beijing Chaoyang Hospital, Capital Medical University, Beijing, 100043, People’s Republic of China; 2Department of Orthopedics, Civil Aviation General Hospital, Beijing, 100123, People’s Republic of China

*These authors contributed equally to this work

Correspondence: Lei Zang, Department of Orthopedics, Beijing Chaoyang Hospital, Capital Medical University, Beijing, People’s Republic of China, Email zanglei@ccmu.edu.cn Shuo Yuan, Department of Orthopedics, Beijing Chaoyang Hospital, Capital Medical University, Beijing, People’s Republic of China, Email happyshuohappy@163.com

Purpose: This study aimed to examine the correlation between diffusion tensor imaging (DTI) parameters (fractional anisotropy, FA; apparent diffusion coefficient, ADC) and clinical outcomes (neck disability index, NDI; visual analog scale, VAS) in cervical spondylotic radiculopathy (CSR) patients following percutaneous cervical nucleoplasty (PCN), respectively.
Methods: This is a cross-sectional study. We collected clinical data from 30 patients with CSR who underwent DTI before and 3 months after PCN. The FA and ADC were derived from DTI. The NDI and VAS were used to evaluate the clinical symptoms preoperatively, at 3 months postoperatively, and at the final follow-up. By setting multiple region of interest areas, the cervical nerve roots were delineated using fiber tractography. The Pearson correlation analysis was used to investigate the relationship between DTI values and clinical severity.
Results: NDI and VAS scores after PCN were significantly improved compared with preoperative scores (P < 0.05). The FA and ADC values after PCN were significantly different from the preoperative values (P < 0.001). The Pearson correlation revealed that preoperative FA values were strongly correlated with preoperative NDI scores (r = − 0.802, P < 0.001), whereas postoperative FA values were strongly correlated with postoperative NDI scores (r = − 0.804, P < 0.001). Furthermore, postoperative FA values were strongly correlated with NDI scores at the final follow-up (r = − 0.805, P < 0.001). However, no significant difference was observed between the DTI and VAS scores. Similarly, no significant correlations were observed between ADC values and NDI scores pre- and postoperatively.
Conclusion: DTI is an imaging method that helps identify the clinical functional status of patients with CSR after PCN. The FA value can be used as a potential predictor of patient prognosis and are strongly negatively correlated with NDI scores. However, the long-term predictive effect warrants further investigation.

Keywords: cervical spondylotic radiculopathy, percutaneous cervical nucleoplasty, diffusion tensor imaging, fractional anisotropy, apparent diffusion coefficient, clinical outcome