Objective To investigate the use of serum serotonin (5-Hydroxytryptamine, 5-HT) levels, multi-slice spiral CT (MSCT), and diffusion tensor imaging (DTI) in the diagnosis of lumbar disc herniation (LDH). Methods A retrospective analysis was conducted on 73 LDH patients diagnosed with L3/L4~L5/S1 lumbar disc herniation causing nerve root compression in our hospital from September 2022 to August 2024 (study group), and 80 healthy volunteers (control group) were selected during the same period. All subjects underwent lumbar DTI and MSCT examinations to detect serum 5-HT levels. The lumbar DTI imaging measurement indicators [anisotropy score (FA), apparent diffusion coefficient (ADC)] and MSCT parameters [sagittal flexion angle (SCA), endplate flexion depth (ECD)] of L3/L4~L5/S1 intervertebral disc segments with different Pfirrmann grades in the research group were compared, and the correlation was analyzed. The imaging parameters and serum 5-HT levels between the study group and the control group were compared, logistic regression analysis was performed, and plot receiver operating characteristic (ROC) curves to analyze the diagnostic value of each indicator for LDH. Results There were statistically significant differences (P<0.05) in the FA, ADC, SCA, and ECD values of L3/L4~L5/S1 intervertebral disc segments with different Pfirrmann grades. Pfirrmann grading was positively correlated with FA intervertebral disc and SCA values (P<0.05), and negatively correlated with ADC intervertebral disc and ECD values (P<0.05). The mean values of FA nerve roots and ECD in the L3/L4~L5/S1 segment of the study group were lower than those in the control group. The mean values of ADC nerve roots, SCA, and serum 5-HT levels in the L3/L4~L5/S1 segment of the study group were higher than those in the control group, and the differences were statistically significant (P<0.05). Logistic regression analysis showed that FA nerve roots (OR=0.000, 95% CI 0.000~0.690), ADC nerve roots (OR=20.151, 95% CI 0.209~1940.734), SCA (OR=1.745, 95% CI 1.321~2.305), ECD (OR=0.056, 95% CI 0.005~0.619), and serum 5-HT (OR=1.084, 95% CI 1.039~1.130) were independent risk factors for LDH (P<0.05). Logit (P)=-92.885-20.925FA nerve root+3.003ADC nerve root+0.557SCA-2.890 ECD+0.081 5-HT. The ROC analysis results showed that the mean values of FA nerve roots, ADC nerve roots, SCA, and ECD, serum 5-HT levels, and joint prediction in the L3/L4~L5/S1 segment were statistically significant for the diagnosis of LDH (P<0.05), indicating high predictive value of joint prediction, AUC=0.985, the sensitivity was 94.5% and the specificity was 95.0%. Conclusions The lumbar DTI imaging measurement indicators, including intervertebral disc FA and ADC values, as well as MSCT parameters SCA and ECD, can effectively diagnose lumbar degeneration in the L3/L4~L5/S1 segment of LDH. The nerve root FA and ADC values measured by lumbar DTI show significant changes in LDH patients with nerve root compression injury. The combination of MSCT parameters SCA, ECD, and 5-HT has diagnostic value for LDH.
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