Improved Cosmetic Outcome with Bilateral Paraspinal Muscle Flap Closure Following Cervical Laminectomy and Fusion

BACKGROUND: Poor cosmetic results following cervical laminectomy and fusion (CLF) are rarely considered in assessing surgical complications. Atrophy from muscle denervation and posterior bone loss may result in a sunken appearance; relative tension may lead to wide, unsightly scars. Paraspinal muscle flaps are routinely employed by plastic surgeons for closure of wound infection and dehiscence. OBJECTIVE: To assess clinical and cosmetic results of CLF with/without a paraspinal muscle flap closure technique. METHODS: A retrospectively collected cohort analysis was undertaken for a 12-yr period in CLF patients. During the study period, a paraspinal muscle flap closure technique was adopted. Wounds were inspected for scar width and depth using a scale devised to categorize the posterior neck contour. Minimum follow-up was 12 mo. RESULTS: Of 159 patients, 94 wounds were evaluated of which 34 had muscle flap closure. There were no differences in age, sex, body mass index, mJOA scores, diabetes status, or number of spinal levels treated. Mean follow-up was 18.6 (12-48) and 49.8 (12-130) mo in the muscle flap and conventional closure groups respectively; contour scores were 1.20 vs 2.65 (P <. 00001) and scar width was 2.8 vs 4.9 mm (P <. 0001). No patient had a wound complication in the muscle flap group and 4 (7%) in the conventional closure group. CONCLUSION: Paraspinal muscle flap closure of CLF improved cosmetic appearance in terms of wound contour and scar width. Further investigation is needed to determine any effect upon wound infection and dehiscence rates.