How can spinous process splitting approach in lumbar spine surgery preserve the para-spinal muscles? Quantitative pre- and post-operative Dixon MRI assessment
Abstract Background The spinous process splitting procedure is a muscle sparing approach that could be considered as minimally invasive for para-spinal muscles allowing decompression of the spinal canal without significant muscle violation. T1-Dixon MRI could effectively assess the para-spinal muscu...
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| Main Authors: | , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
SpringerOpen
2025-05-01
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| Series: | The Egyptian Journal of Radiology and Nuclear Medicine |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s43055-025-01471-8 |
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| Summary: | Abstract Background The spinous process splitting procedure is a muscle sparing approach that could be considered as minimally invasive for para-spinal muscles allowing decompression of the spinal canal without significant muscle violation. T1-Dixon MRI could effectively assess the para-spinal musculature for volume reduction or intra-muscular fat infiltration. The aim of this study was to assess the influence of spinous process splitting procedure utilized in spine decompression surgery in preservation of para-spinal muscle status using T1-Dixon MRI with an emphasis on quantitative histogram analysis of muscle volume and signals. Methods Thirty-three patients candidate for lumbar decompression surgery underwent pre- and postoperative T1-Dixon MRI of lumbosacral spine with quantitative histogram of the fat only images and analysis of signal-oriented and volume-oriented features. All patients underwent decompression surgery employing the spinous process splitting approach. Results There was significant postoperative improvement of Oswestry disability index and visual analogue scale scores. The 6-min walk distance showed significant postoperative improvement from (282.58 ± 69.03) meters to (628.79 ± 79.09) meters. The quantitative histogram analysis of fat-only Dixon MR images showed minimal statistically insignificant postoperative decrease in volume and minimal statistically insignificant postoperative increase in histogram skewness values which represent signal alteration of the muscle fibers. At 6-week follow-up, all patients returned to their pre-symptomatic level of activity and work. At 6-month follow-up, there is no radiographic evidence for instability in either case or either level (total number of cases 33 patients with 42 levels). There is no recorded postoperative infection or neurologic deficits. Conclusions T1-Dixon MRI is a reliable and valuable imaging method with a proper diagnostic performance in para-spinal muscle evaluation; it could prove the less invasiveness property of the spinous process splitting approach employed in spine decompression surgery to the para-spinal muscle with excellent preservation of their volume and signal. |
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| ISSN: | 2090-4762 |