Paraspinal muscle flap advancement to reduce wound complications following posterior cervical decompression and fusion.

Abstract

Paraspinal muscle flaps have been used for complex wound reconstruction. Given the higher rates of wound complications associated with closure following posterior cervical decompression and fusion (PCDF), this study evaluated the use of paraspinal muscle flap advancement to mitigate this recognized risk. A retrospective cohort of patients who underwent PCDF with conventional closure at an academic quaternary center between 2011 and 2022 was identified. Postoperative outcomes were compared with those of a prospectively maintained cohort of patients who underwent PCDF with paraspinal muscle flap advancement performed between 2023 and 2025. Exclusion criteria included active local or systemic infection and less than 3 months of follow-up. A total of 380 patients underwent conventional closure, and 128 patients underwent closure with muscle flap advancement. Baseline characteristics were similar across cohorts, including BMI (p = 0.466) and the prevalence of diabetes mellitus (p = 0.597) and osteoporosis (p = 0.256). The muscle flap cohort was older (p = 0.004) and had higher rates of tobacco use (p = 0.002). There were no differences in preoperative prealbumin (p = 0.427) or albumin (p = 0.527). Operative indications (p = 0.568), revision surgeries (p > 0.999), estimated blood loss (p = 0.465), and number of spinal levels fused (p = 0.067) were not significantly different between the cohorts. Rates of wound complications were comparable between the conventional and muscle flap cohorts, including infection (8% vs 3%, p = 0.132), wound dehiscence (12% vs 11%, p = 0.670), hematoma (1% vs 0%, p = 0.576), and seroma (5% vs 9%, p = 0.429). Wound-related reoperation occurred less frequently following muscle flap closure (12% vs 7%, p = 0.021). On multivariable logistic regression analysis, muscle flap closure was associated with reduced odds of infection (p = 0.005; OR 0.275, 95% CI 0.085-0.702) and wound-related reoperation (p = 0.026; OR 0.445, 95% CI 0.198-0.912). Paraspinal muscle flap advancement following PCDF was associated with reduced odds of infection and wound-related reoperation after adjustment of preoperative and operative factors.