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Comparative Study
. 2018 Mar 7;19(1):75.
doi: 10.1186/s12891-018-2001-2.

Quantitative MRI comparison of multifidus muscle degeneration in thoracolumbar fractures treated with open and minimally invasive approach

F Gilbert  1 , T M Heintel  2 , M G Jakubietz  2 , H Köstler  3 , C Sebald  2 , R H Meffert  2 , A M Weng  3
Affiliations
Comparative Study

Quantitative MRI comparison of multifidus muscle degeneration in thoracolumbar fractures treated with open and minimally invasive approach

F Gilbert et al. BMC Musculoskelet Disord. .

Abstract

Background: Minimally invasive pedicle screw fixation has less approach-related morbidity than open screw placement and is allegedly less traumatizing on paravertebral muscles, as there is no requirement to mobilize and retract the adjacent muscle portion. The approach-related long-term effects to the morphology of the paravertebral muscles are unknown. The purpose of this study was to compare the long-term amount of fatty degeneration of the multifidus muscle in patients treated with a classical open or a minimally invasive approach.

Methods: Fourteen Patients meeting inclusion criteria were selected. In all patients a singular fracture of the thoracolumbar spine with a two-level posterior instrumentation was treated, either using an open approach or a minimally invasive approach. All patients underwent quantitative MRI spectroscopy for quantification of the fatty degeneration in the multifidus muscle as a long-term proof for muscle loss after minimum 4-year follow-up. Clinical outcome was assessed using Oswestry Low Back Pain Disability Questionnaire, SF-36 and VA-scale for pain.

Results: The minimally invasive approach group failed to show less muscle degeneration in comparison to the open group. Total amount of fatty degeneration was 14.22% in the MIS group and 12.60% in the open group (p = 0.64). In accordance to MRI quantitative results there was no difference in the clinical outcome after a mean follow up of 5.9 years (±1.8).

Conclusion: As short-term advantages of minimal invasive screw placement have been widely demonstrated, no advantage of the MIS, displaying a significant difference in the amount of fatty degeneration and resulting in a better clinical outcome could be found. Besides the well-known short-term advantage of minimally invasive pedicle screw placement, a long-term advantage, such as less muscle degeneration and thus superior clinical results, compared to the open approach could not be shown.

Keywords: Dorsal instrumentation; Minimal invasive surgery; Muscle degeneration; Spine trauma.

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Conflict of interest statement

Ethics approval and consent to participate

We declare that the study has been performed in accordance with the Declaration of Helsinki and has been approved by the ethical Committee of the University of Würzburg (Ethical Committee Approval: Nr: 55/15 Date 1st Februar 2015).

Written informed consent to participate in the study was obtained from each participant.

Consent for publication

Not applicable

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
A quantitative MR-spectroscopy was performed and the fat amount in the multifidus muscle was measured at the fracture level and the adjacent vetebrae
Fig. 2
Fig. 2
MR-spectroscopy revealed a fat amount of 12.6% (±6.3) for the open and a amount 14.2% (±5.3) for the MIS group. The upper and the lower whisker of boxplots represent the standard deviation. The heights of box represents the interquartile range (25% and 75% quartile). The line in the middle represents the median
Fig. 3
Fig. 3
Open approach (a) for pedicle screw placement and Minimal invasive approach (b)
Fig. 4
Fig. 4
T1-weighted transversal imagfe of the paravertebral muscles. MR spectroscopy reveald a fat amount of 26.5% for the multifidus muscle in a and an amount of 5.6% in b
See this image and copyright information in PMC

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