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[Comparison of MRI of Paraspinal Muscles in Patients after Open and Minimally Invasive Percutaneous Stabilisation of
Tomáš Matějka1, Jiří Matějka1, Jaroslav Zeman1
1Department of Orthopaedics and Trauma of Locomotive Apparatus, University hospital and Faculty of Medicine in Plzen, Charles University, Czech Republic.
Purpose Of The Study:
Magnetic resonance imaging (MRI) was used to evaluate paraspinal muscle damage after classic open surgery (OPEN) and minimally invasive spine surgery (MISS) after injury. In a randomised prospective study, we evaluated our hypothesis that MISS would result in a lower extent of atrophy and fibrosis as detected by MRI.
Material And Methods:
MRI was performed after the injury and not earlier than 3 months after the removal of implants. 16 OPEN and 16 MISS patients underwent the final follow-up. Both atrophy and muscle fibrosis were assessed based on the progression of the condition after the surgery from the pre-operative state. Atrophy was assessed using T2-weighted axial scans based on the progression of fat tissue growth in the muscle and muscle tissue regression, while muscle fibrosis was assessed using T1-weighted scans before and after the administration of a contrast agent.
Results:
Mean fibrotic changes were found to be higher in the OPEN group than in the MISS group, but insignificantly (p = 0.1100). Muscular atrophy was higher in the MISS group (p = 0.2099). Occurrence of fibrosis correlated positively with muscular atrophy only in the MISS group (R = 0.617 (0.174-0.852), p = 0.0094).
Discussion:
Minimally invasive percutaneous methods of spinal stabilization and other types of less invasive spinal surgeries are more gentle to the paraspinal muscles than standard OPEN approaches. Their importance is clear despite certain disadvantages such as longer duration of surgery and higher radiation exposure (in case of insertion without robotic assistance or 3D CT guidance). The condition of the paraspinal muscles is more suitable for the follow-up physiotherapy, enabling easier and quicker recovery. In the long term, the muscles are more capable of maintaining spinal balance and allowing for a wider range of movement, despite in this study is a mild controversy in the higher percentage of muscle atrophy in MISS procedures.
Conclusions:
MISS procedures are more gentle to the paraspinal muscles than OPEN procedures. The condition of muscles is better for physiotherapy, enabling easier and quicker recovery.
Insights
Minimally invasive spine surgery (MISS) causes less paraspinal muscle damage than open surgery (OPEN). While MISS showed higher muscle atrophy, both fibrosis and atrophy indicate MISS is gentler on muscles, aiding recovery.
Area of Science:
- Spine surgery outcomes
- Musculoskeletal imaging
- Paraspinal muscle evaluation
Background:
- Classic open surgery (OPEN) and minimally invasive spine surgery (MISS) have different impacts on paraspinal muscles.
- Assessing post-surgical muscle damage is crucial for patient recovery and long-term spinal function.
Purpose of the Study:
- To compare paraspinal muscle damage, specifically atrophy and fibrosis, between OPEN and MISS using Magnetic Resonance Imaging (MRI).
- To test the hypothesis that MISS results in less muscle atrophy and fibrosis compared to OPEN surgery.
Main Methods:
- A randomized prospective study involving 16 patients undergoing OPEN and 16 undergoing MISS.
- MRI scans were performed post-injury and at least 3 months after implant removal.
- Muscle atrophy assessed via T2-weighted scans (fat infiltration, tissue regression); fibrosis assessed via T1-weighted scans (pre- and post-contrast).
Main Results:
- Mean fibrotic changes were higher in the OPEN group, though not significantly (p=0.1100).
- Muscular atrophy was more prevalent in the MISS group (p=0.2099).
- A positive correlation between fibrosis and atrophy was observed exclusively in the MISS group (R=0.617, p=0.0094).
Conclusions:
- Minimally invasive spine surgery (MISS) procedures are gentler on paraspinal muscles compared to standard OPEN approaches.
- Better muscle condition post-MISS facilitates easier and quicker recovery and physiotherapy.
- Long-term benefits include improved spinal balance and range of motion, despite some observed muscle atrophy in MISS.
