Why the scar is usually long
When adolescent scoliosis needs surgery, the correction is done from the back, with pedicle screws placed vertebra by vertebra along the curve to correct it in all three planes. The incision covers that stretch but does not follow the curve: it is a straight line down the middle of the back, from the highest to the lowest vertebra that needs instrumenting.
So its length is not an aesthetic choice by the surgeon, but a consequence of how much of the curve has to be corrected. Being straight has an advantage: it sits centred on the back and follows the axis of the body even though the spine underneath is curved, so it looks better than if it followed the shape of the scoliosis.
When it is not a single long scar
In some situations the approach is different. In adolescents, the ApiFix MID-C system is anchored at a few points on the concave side of the curve through small incisions; but its indications are very limited —a single, flexible curve of moderate size— and most scolioses do not fit that profile.
In adult degenerative scoliosis I favour less aggressive strategies: lateral and oblique approaches that leave an incision on the side, and percutaneous fixation, which leaves several small incisions in the back instead of one long one. Sometimes the correction is spread over more than one operation.
In every case, the shape of the scar is a consequence of the technique, not a reason to choose it: the choice is whatever best corrects your curve with the least aggression necessary.
The first days: caring for the wound
When you are discharged we explain how to care for your wound: when and how to shower, whether there are stitches or staples to be removed or an internal suture that stays in, and when your check-up is. Those instructions come before any general advice, including this.
I often close the skin with an intradermal suture, placed under the skin, so that there are no stitch or staple marks, only the line of the incision. It is not always the best choice: if the skin is under tension, that suture can give way and the wound can open more easily, and then stitches or staples are safer.
Until it has fully closed, keep it clean and dry, do not put on creams or home remedies we have not suggested, and do not pick the scabs. Showering depends on how the wound was closed: with staples you can shower while they are in, as long as you then dry the wound completely, patting rather than rubbing, and apply an antiseptic such as povidone-iodine or chlorhexidine; with an intradermal suture it is better not to shower for two weeks. Baths, swimming pools and the sea: never before one month, and only if no part of the wound is still tender.
How it changes over the months
A scar is not finished when the skin closes. For the first few months it is normal for it to be pink or red, slightly thickened and itchy; then, little by little, it flattens and fades. This maturing takes around a year, sometimes longer, so do not judge it by how it looks after a few weeks.
Sometimes the suture leaves the skin tethered to the layers underneath, and when you stand up small irregularities or bumps appear along the scar; this is more common after a fusion. They were not visible in theatre because you were lying down: it is the change of posture that brings them out. They can look striking, but they do not matter and they settle on their own in about three months.
On the back the skin stretches every time you bend forward, and in a teenager who is still growing the scar may widen slightly over time. That is how skin behaves in that area, not a failure of the surgery.
What helps it heal better
Once the wound has closed, some things are in your hands:
- Keep it out of the sun while it is still pink, under clothing or with high-factor sunscreen. Sun on a scar that is still maturing can darken it for good.
- Gentle massage with a moisturising cream, along the scar and in small circles, so the skin does not stick to the layers underneath.
- Silicone sheets or gels, if we recommend them: a simple, widely used way to stop the scar thickening.
- Do not smoke. Smoking impairs skin healing and, if the operation included a fusion, bone healing too.
- If you are diabetic, keep your blood sugar well controlled, which also affects how the wound heals.
When to get in touch without waiting for your check-up
Call the clinic or go to A&E if you notice any of the following:
- Redness spreading around the wound, or warmth in the area.
- Pain in the wound that gets worse over the days instead of easing.
- Discharge, a bad smell or fever.
- Wound edges that come apart.
- Clear fluid that keeps leaking: after spine surgery it can be cerebrospinal fluid and needs to be checked soon, especially if it comes with a headache.
- Pain, tingling or weakness in the legs (or the arms, after neck surgery) that you did not have when you left hospital.