Background:
Paraspinal muscle degeneration, particularly of the multifidus, is a recognized consequence of spinal surgery and may contribute to postoperative pain and altered spinal biomechanics. However, its association with Modic changes (MCs)—MRI-detectable endplate and marrow lesions—remains poorly understood in the context of minimally invasive techniques (MITs).
Objective:
To determine whether postoperative degeneration of the multifidus muscle is associated with the progression or new onset of Modic changes in patients undergoing MIT.
Methods:
We retrospectively analysed lumbar MRI scans of 50–200 patients who underwent MIT for degenerative lumbar disorders. Both preoperative and follow-up MRIs (≥6 months postoperative) were reviewed. Paraspinal muscle status (cross-sectional area and fatty infiltration) was quantitatively assessed using axial T2-weighted or Dixon sequences. Modic changes were graded (Type 0–3) at each level pre- and postoperatively. Patients were categorized into three groups: (1) no Modic changes, (2) stable Modic changes, and (3) progressive Modic changes (newly developed or worsened). Multivariate logistic regression was used to assess associations between multifidus degeneration and Modic progression, adjusting for age, BMI, smoking, and surgical factors.
Results (anticipated):
We anticipate that patients with Modic progression will exhibit greater multifidus atrophy and fatty infiltration compared to those with stable or no changes
Conclusion:
This study explores the underappreciated link between muscle degeneration and vertebral bone marrow changes following MIT. The findings may highlight the importance of preserving paraspinal muscle integrity to mitigate postoperative structural deterioration and long-term back pain.