Is Muscle Flap Reconstruction Effective in Spine Surgery? A Systematic Review and Meta-analysis

Introduction: Muscle flap reconstruction after spine surgery has been associated with favorable postoperative outcomes. However, a lack of prospective studies and the influence of confounding variables, such as patient comorbidities, limit accurate efficacy assessment. This study offers a pooled analysis of characteristics and outcomes of muscle flap reconstruction after spine surgery from existing literature.

Methods: A systematic review and meta-analysis were conducted following PRISMA 2020 guidelines. Articles were included if they characterized spine surgery patients with flap reconstruction and reported infection, wound dehiscence, or reoperation outcomes. A meta-analysis compared outcomes after spine surgery with and without muscle flap reconstruction using risk ratios and 95% confidence intervals (CI) in a random-effects model (p < 0.05). Forest plots were constructed for each outcome. Subgroup analyses were performed for adult and pediatric populations, as well as immediate and delayed wound closure cohorts.

Results: After applying exclusion criteria, 45 articles were included. Eight (17.8%) articles included specifically pediatric populations. The most common flap was paraspinous (30, 66.7%), followed by latissimus dorsi (27, 60.0%), trapezius (24, 53.3%), and gluteal (13, 28.9%). The pooled rates of smoking, previous radiation, and diabetes were 26.2%, 26.4%, and 23.6% in the flap reconstruction cohort, compared to 21.9%, 8.8%, and 17.4% in the simple closure cohort. Cases with flap reconstruction involved a mean of 5.7 vertebral levels versus 3.6 levels in simple closure cases. Meta-analysis showed no significant differences in infection (RR: 0.86, 95% CI: 0.39-1.89), wound dehiscence (RR: 0.81, 95% CI: 0.41-1.61), or reoperations (RR: 1.27, 95% CI: 0.67-2.41) between the two cohorts. Subset analysis of immediate reconstruction cases excluding pediatric populations also showed no significant outcome differences (p>0.05).

Conclusion : Cases with muscle flap reconstruction after spine surgery are associated with increased comorbidities, including higher rates of smoking, prior radiation, diabetes, as well as more vertebral levels involved during surgery. Despite this, postoperative outcomes were comparable to simple closure, underscoring the utility of muscle flap reconstructions in managing high-risk patients. Future studies may consider prospective designs to better assess efficacy.