What its size depends on
Above all, on the technique and the route to the herniation. In a micro-approach the surgeon goes in from one side only, under the microscope, through a small opening next to the midline of the back. In endoscopic spine surgery an optic a few millimetres wide goes in through the natural opening where the nerve root exits, a little further to the side.
Each patient matters too: the more tissue there is between the skin and the spine, the longer the path that has to be opened to work safely. And if the herniation is in the neck and is operated from the front, the incision is at the front of the neck, using a natural skin crease where possible.
The scar is the least of it
Minimally invasive does not necessarily mean a smaller incision. It means harming healthy tissue as little as possible, with one condition that comes first: solving the problem as well as the classic technique does. What a micro-approach really offers is that it does not strip the muscles or remove the structures that keep the segment stable; the millimetres of skin are secondary.
That is why the technique is chosen for the herniation —where it is, what it is like, whether there is also stenosis— and not for the scar it leaves.
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.
With a small incision the skin is usually under little tension, so I often close it with an intradermal suture, placed under the skin, so that there are no stitch or staple marks, only the line of the incision. If the skin is tight, 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.
What is normal to feel
Around the scar the skin often feels slightly numb or different: small skin nerves are cut when the incision is made, and that feeling usually improves over the months. Some local discomfort at first, when moving or leaning on it, is also common.
Pain running down the leg is another matter. If the pain you had before surgery comes back, or a new one appears, it does not come from the scar and you should get in touch.
How it changes over time
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.
If the skin is very loose and elastic, the suture may leave it tethered to the layers underneath, and small irregularities or bumps may appear along the scar when you stand up. It is more typical after a fusion, but it can also happen after herniated disc surgery. 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.
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.