Research progress of diffusion tensor imaging in lumbar degenerative diseases: a narrative review

J Orthop Surg Res https://doi.org/10.1186/s13018-026-06924-y Article in Press Research progress of diffusion tensor imaging in lumbar degenerative diseases: a narrative review Nan Zhang, Zemin Zhao, Jinlin Tian & Yang Xu Received: 11 March 2026 Accepted: 1 May 2026 Cite this article as: Zhang N., Zhao Z., Tian J. et al. Research progress of diffusion tensor imaging in lumbar degenerative diseases: a narrative review. J Orthop Surg Res (2026). https:// doi.org/10.1186/s13018-026-06924-y A We are providing an unedited version of this manuscript to give early access to its findings. Before final publication, the manuscript will undergo further editing. Please note there may be errors present which affect the content, and all legal disclaimers apply. S S If this paper is publishing under a Transparent Peer Review model then Peer Review reports will publish with the final article. I T R E L C IN E R P © The Author(s) 2026. 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To view a copy of this licence, visit http://creativecommons.org/licenses/by-nc-nd/4.0/. ACCEPTED ARTICLEMANUSCRIPT IN PRESS Research progress of diffusion tensor imaging in lumbar degenerative diseases: a narrative review Nan Zhang1+, Zemin Zhao2+, Jinlin Tian1 and Yang Xu1* +Nan Zhang and Zemin Zhao are co-first authors who equally contributed to this manuscript. *Correspondence: Yang Xu Email: 1Medical Imaging Department, 82nd Group Army Hospital, People's Liberation Army, Baoding 071000, Hebei, China Email: 2North S S E R P China University of Technology Tangshan 063200, Hebei, China Abstract IN Degenerative diseases of the lumbar spine are a common cause of chronic E L C I T R A low back pain and neurological dysfunction. Their pathological basis involves not only microscopic structural damage to the intervertebral discs but also microscopic injury to adjacent nerves and muscle tissues. Diffusion tensor imaging (DTI), which relies on the anisotropic properties of water molecule diffusion, enables non-invasive, quantitative assessment of microscopic structural changes in intervertebral discs, nerve fiber bundles, and muscle tissues. Studies have shown that DTI-related parameters—fractional anisotropy (FA), apparent diffusion coefficient (ADC), and other parameters show a strong correlation with the degree of degeneration, nerve compression, and clinical symptoms in lumbar degenerative diseases such as intervertebral disc degeneration, lumbar disc ACCEPTED ARTICLEMANUSCRIPT IN PRESS herniation, and stenosis of the spinal canal and intervertebral foramen. These parameters can provide imaging evidence for identifying the affected segment and evaluating treatment efficacy. This review summarizes the recent advances in the application of DTI in lumbar degenerative diseases, with the aim of providing a reference for the clinical application of DTI and future research. Keywords Diffusion tensor imaging, Lumbar degenerative disease, Intervertebral disc degeneration, Lumbar disc herniation, Lumbar spinal stenosis, Lumbar foraminal stenosis, Paraspinal muscle changes, Artificial intelligence Introduction IN S S E R P Lumbar disc herniation, foraminal stenosis, and spinal canal stenosis are E L C I T R A common degenerative conditions with high incidence. By compressing nearby neural structures and triggering inflammation, they can cause microscopic damage. This is the main reason patients end up with pain, odd sensations, or trouble moving. It gets in the way of daily life. Therefore, the precise clinical assessment of the involved nerve roots and the degree of neural injury is pivotal for formulating therapeutic plans and prognosticating outcomes. Conventional magnetic resonance imaging (MRI), however, has inherent limitations in evaluating radicular function, as it cannot comprehensively visualize the course of nerve roots or assess their microstructural and functional integrity. DTI, an MRI technique that can show the direction of water molecule ACCEPTED ARTICLEMANUSCRIPT IN PRESS diffusion, uses key parameters like FA and ADC to do a quantitative analysis of nerve damage [1, 2]. DTI is now widely used in clinical settings for different systemic diseases [3-5], especially in research and clinical settings for the central nervous system [6, 7]. This has laid the groundwork for its use in evaluating spinal diseases. While there have been many studies on DTI's use in assessing the microscopic structure of compressed nerves in patients with lumbar disc herniation, there have been fewer studies on its use in other degenerative diseases. This article aims to review recent literature on DTI's clinical application status in different degenerative S S E R P lumbar lesions, briefly summarize the latest developments in AI technology for optimizing DTI workflows, and provide new ideas and directions for IN promoting DTI technology in the clinical application of lumbar degenerative diseases ( Fig. 1). E L C I T R A ACCEPTED ARTICLEMANUSCRIPT IN PRESS E L C I T R A IN S S E R P Fig. 1 Flowchart illustrating the diagnostic framework of DTI in lumbar degenerative diseases. The flowchart outlines identifying symptomatic levels, quantifying microstructural damage, and predicting clinical outcomes—along with current challenges and future. DTI technology principle Diffusion-weighted imaging (DWI) gave rise to DTI, a functional MRI technique. It works by measuring the differences in how water molecules diffuse through different types of tissue. It does this by applying a diffusion-sensitive gradient field in at least six different directions in three-dimensional space. This allows for the quantification of the anisotropic characteristics of water molecules inside living cells [8]. In the ACCEPTED ARTICLEMANUSCRIPT IN PRESS nervous system, highly organized fiber bundles provide direction for water molecules to diffuse. Water molecules can diffuse freely along the long axis of the nerve fibers, but they are limited in the vertical direction by the myelin sheath (...truncated)