Acta chirurgiae orthopaedicae
et traumatologiae Čechoslovaca

Acta Chir Orthop Traumatol Cech. 2026; 93(1):22-28 | DOI: 10.55095/achot2025/033

Comparison of MRI of Paraspinal Muscles in Patients after Open and Minimally Invasive Percutaneous Stabilisation of Thoracic and Lumbar Spine Fractures

Tomáš Matějka¹, Jiří Matějka¹, Jaroslav Zeman¹, Jaroslav Belatka¹, Martin Salášek^{1, 2}

¹ Department of Orthopaedics and Trauma of Locomotive Apparatus, University hospital and Faculty of Medicine in Plzeň, Charles University, Czech Republic

² New Technologies for Information Society, University of West Bohemia, Plzeň, Czech Republic

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.



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.



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).

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.



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.

Keywords: spine, fracture, rehabilitation, muscles, minimally invasive spine surgery, magnetic resonance imaging, fibrosis, muscular atrophy.

Received: May 23, 2025; Revised: May 23, 2025; Accepted: August 25, 2025; Published: March 1, 2026  Show citation