The spinal manifestations of neurofibromatosis include cervicothoracic kyphosis, in which scalloping of the vertebral body and erosion of the pedicles may render conventional techniques of fixation impossible. We describe a case of cervicothoracic kyphosis managed operatively with a vascularised fibular graft anteriorly across the apex of the kyphus, followed by a long posterior construct using translaminar screws, which allow segmental fixation in vertebral bodies where placement of the pedicle screws was impracticable.

Patients requiring posterior fixation of the cervical spine are often elderly and frequently suffer from concurrent connective tissue disease together with steroid therapy. These patients are at increased risk of wound infection and breakdown. The extensive tissue dissection required, and the bulk of the posterior spinal devices may lead to difficult wound closure and delayed wound healing.

Over a four-year period, 1997 – 2001, 54 patients underwent posterior cervical spine fixation. Of these, eleven patients required muscle cover, four at the time of initial surgery and seven as a delayed procedure for wound breakdown. All these patients underwent trapezius muscle flap reconstruction (ten unilateral, one bilateral) which resulted in successful wound healing.

We make several recommendations for prevention of wound breakdown in this patient population. These include modification of the screw and rod fixation system to reduce the bulk, and assessment of the wound at the end of the primary procedure with a view to primary trapezius muscle flap transposition in those patients who are at risk of wound breakdown.