Where it sits, depending on the approach
Each technique goes in at a different place, and that decides where the scar will be:
- Down the middle of the back: most decompressions, such as canal recalibration or laminectomy, and fusions and corrections from the back. Its length follows the number of levels to be treated.
- Several small incisions in the back: minimally invasive lumbar fusion (MIS-TLIF) and percutaneous fixation, in which the screws go in through the skin.
- On the side: lateral (XLIF) and oblique (OLIF) fusions, through a single incision that can reach several levels.
- Low on the abdomen: anterior lumbar fusion (ALIF) and lumbar disc replacement. The back is not touched and no scar is left on it.
- At the front of the neck: cervical surgery from the front, such as cervical disc replacement.
- On the buttock: fixation of the sacroiliac joint, through a small incision.
They are often combined: a fusion from the side completed with percutaneous screws, for example, leaves a scar on the side and several small ones in the back. Before surgery we explain where yours will be.
Why the scar does not decide the technique
Minimally invasive does not mean a smaller scar: it means solving the problem with the same guarantees as conventional surgery while harming healthy muscle, ligament and bone as little as possible. If a smaller incision made the result worse, it would not be less invasive, just more cosmetic.
What makes an operation aggressive is what is done beneath the skin. That is why the approach is chosen for what needs correcting and for your anatomy, and the scar follows from it.
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.
Sun, water and sport
Sun: while the scar is still pink, protect it with clothing or high-factor sunscreen. It is the measure that does most to stop it darkening.
Water: showering depends on how the wound was closed (see above). Baths, swimming pools and the sea: never before one month, and only if no part of the wound is still tender.
Sport: it is almost never the scar that limits it, but the operated spine —especially after a fusion—. We will tell you when, and with which activities, to start.
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.
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.
Around the scar the skin often feels slightly numb or different, because small skin nerves are cut when the incision is made; this usually improves over the 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.