The effect of incision size in lumbar disc surgery on post-operative paraspinal muscle healing

Objective: The relationship between muscle sparing effect of subperiosteal microdiscectomy technique and the size of the incision is controversial. In this study, the effect of the use of smaller incision and smaller retractor in subperiosteal microdiscectomy technique on muscle healing and quality of life is investigated. Materials and Methods: This retroprospektif study is conducted on 100 patients who underwent surgery with the diagnosis of lumbar disc herniation in Bülent Ecevit University School of Medicine, Department of Neurosurgery. In this study, two group was formed and result was obtained by comparing the postoperative lumbar MR images of the two groups. Patients were divided into two groups including those of having conventional subperiosteal lumbar microdiscectomy with greater than 2 cm midline incision and the use of a large standard retractor (Taylor and large Caspar) and having conventional subperiosteal lumbar microdiscectomy with smaller than 2 cm midline incision and the use of a small standard retractor (mini Caspar). MR imaging, which can show the decrease in muscle size and the increase in fat accumulation, has become the preferred method of this research. Results: There was no statistically significant effect of gender, age, systemic diseases, early or late mobilization on postoperative paraspinal muscle atrophy between the two groups. A statistically significant effect of the retractor used in surgery and the size of the incision was observed (P = 0.001). In the small retractor and small incision group, atrophy was not detected in 60% of patients. In this group, mild atrophy in 28%, moderate in 10% and severe atrophy in 2% of patients were detected. In the large retractor and large incision group, although there was no reveal atrophy in 28% of patients, mild atrophy in 26%, moderate in 36% and severe atrophy in 10% of patients were detected. Conclusions: Perioperative tissue trauma is known to be associated with subsequent muscle denervation and atrophy. In this study, minimizing the development of muscle atrophy suggests that performing microdiscectomy with small retractor and small incision has muscle tissue protective properties. It also encourages the use of these techniques in the treatment of lumbar disc herniation.