Qualitative Evaluation of Paraspinal Musculature After Minimally Invasive Lumbar Decompression: A Prospective Study

Area of Science:

• Spine surgery
• Orthopedics
• Neurosurgery

Background:

• Paraspinal muscle degeneration is a concern after lumbar disc herniation surgery.
• Quantifying fatty infiltration and muscle degeneration is crucial for understanding surgical impact.

Purpose of the Study:

• To compare fatty infiltration and multifidus muscle degeneration between tubular microdiscectomy and conventional open microdiscectomy.
• To assess the impact of these surgical techniques on paraspinal muscles.

Main Methods:

• Prospective cohort study of 32 patients undergoing microdiscectomy for lumbar disc herniation.
• Goutallier system and fat percentage analysis of multifidus muscle using MRI.
• Statistical analysis with Wilcoxon and Spearman tests.

Main Results:

• Fatty infiltration increased significantly in the ipsilateral multifidus muscle after conventional microdiscectomy.
• Both surgical techniques led to increased muscle degeneration (Goutallier grades 1-2).
• No significant difference in fatty infiltration or degeneration between tubular and open microdiscectomy.

Conclusions:

• Lumbar disc surgery, regardless of technique, increases multifidus muscle fatty infiltration and degeneration.
• Worsening back pain is associated with increased muscular degeneration.
• Tubular minimally invasive surgery may offer a trend towards less muscle damage, potentially improving outcomes.