Spine Reconstruction: From Basics to Cutting Edge

Purpose of Review: Plastic surgery reconstruction involving the spinal region may be necessary to fill dead space, buttress a durotomy repair to help prevent or treat a cerebrospinal fluid (CSF) leak, resurface the skin, and/or transfer vascularized bone to augment stabilization after vertebrectomy or sacrectomy. Reconstruction can be employed in the prophylactic setting—in patients at high-risk for wound healing complications – or in the therapeutic setting, to treat wound healing complications after they have occurred. In general, the goals of soft tissue reconstruction include coverage of vitals structures and spinal hardware, obliteration of dead space, and a layered water-tight closure; goals of bony reconstruction include providing a stable vertebral construct by increasing the rapidity and durability of the osseous union. Recent Findings: Paraspinous muscle advancement flaps remain the workhorse for midline posterior trunks wounds. Multiple studies including a systematic review and meta-analysis have established that immediate spinal reconstruction decreases wound complications and increases hardware retention. This approach has been shown to be cost-effective and safe in those considered to be at high-risk for wound healing complications. Regarding osseous reconstruction, transferring vascularized bone is associated with a higher union rate and a shortened time to union in patients requiring vertebrectomy or sacrectomy for primary bony tumors. Summary: Plastic surgery reconstruction remains an important adjunctive maneuver to optimize healing in high-risk spinal surgery patients. A multidisciplinary approach between the spinal surgery team and plastic surgery team is key for surgical planning and patient optimization. It is important to consider the utility of prophylactic spinal reconstruction in patients who are deemed high-risk for wound healing complications (previous spine surgery, previous radiation, obese, diabetes, malnutrition) in order to prevent complications before they occur. Once a postoperative wound healing complication has occurred following spinal surgery, spinal reconstruction can also be pursued with the goal of protecting spinal hardware and preventing impending exposure.