Caring for Your Spinal Surgery Incision

All patients undergoing back surgery should actively ensure that the healing process goes as smoothly as possible. In doing so, you can attain the best possible results from the procedure while avoiding complications that could compromise your health. 

Proper incision care is a key step in the process of adopting healthy habits and positive lifestyle choices to promote healing. As an aspect of your spinal surgery recovery, incision care will benefit your overall health. 

Here, we’ll discuss how to care for a spinal incision to ensure a successful surgical recovery and back pain relief. Additionally, we’ll explore innovations in the field of spine surgery that allow for smaller incisions and, as a result, a lower risk of complications. 

How Are Incisions Closed After Spinal Surgery?

After spinal surgery, the incision may be closed with Steri-Strips, staples, or sutures, including dissolvable sutures. Most often, spinal surgeons use a combination of these closure methods.

Since spinal surgery is performed beneath the layers of skin and muscle in the back, the incision must be closed at various layers. Your surgeon will suture the muscle layer together before closing the skin. 

  • Sutures are also commonly referred to as stitches. This wound closure method involves using sterile surgical threads, which are stronger than the threads most people are familiar with. The surgeon uses these threads with a needle to suture the incision closed, and certain types of sutures will dissolve within a few weeks of the procedure. 
  • Staples are metal clips. They allow for fast wound closure but don’t dissolve. So, you’ll need to return to your surgeon to have them removed after the procedure (typically seven to 14 days post-op). 
  • Steri-Strips are adhesive bandages that may be used to help close an incision after spinal surgery. They may be applied over dissolvable stitches to help keep the skin closed or to help the wound heal after the sutures are removed. 

Preparing and Recovering From Back Surgery

In preparing for back surgery, patients should begin on a path of improving their diet and physical activity. These practices will improve your overall health to ensure that the spinal surgery goes off without a hitch. 

With that said, implementing healthy habits is not only essential for the surgery itself but also for the recovery process following the operation. While continuing the positive lifestyle changes that you applied before the procedure, make sure to rigorously follow your doctor’s orders, including those about what medications to avoid. Certain medications can interfere with the healing process, namely including NSAIDs. NSAIDs, like aspirin, ibuprofen, and naproxen, are blood thinners and can impair the body’s repair processes.

How Do You Treat an Incision After Back Surgery?

Proper care for the surgical incision is one of the most important aspects of post-operative home recuperation following back surgery. 

Immediately After The Procedure

You won’t be permitted to apply any ointments or lotions to the incision while it’s healing. You also shouldn’t bathe in a tub, swim, or use a hot tub until your incision is healed. Immersing the incision in water before your surgeon clears you to do so may increase your risk of infection and inhibit the healing process. 

Additionally, you’ll need to keep the incision clean after spinal surgery. You can clean the incision site with soap and water, then gently dry it with a clean cloth. This helps prevent infection as the incision heals. 

Two Weeks After The Procedure

In most cases, non-dissolvable sutures and staples are removed 14 days following the spinal surgery. At this point, the incision is usually fully healed. 

Six Weeks After The Procedure

Many spinal surgery patients are eager to reduce scarring by applying scar treatments and vitamin creams to the incision. However, you must wait to get the go-ahead from your surgeon before doing so. Typically, surgeons allow patients to start applying scar creams six weeks after the procedure. 

Signs of Proper Incision Healing

Signs that your incision is healing properly after spinal surgery include:

  • A steady decrease in redness and swelling
  • Scabbing
  • Scar formation:
    • Incision edges draw closer together
    • Thickening around the edges
  • Some sharp or shooting sensations in the incision region, indicating nerves in the area are regaining sensation
    • Note: This sensation should become less intense and less frequent over time. If it persists, talk to your doctor. 
  • Thinning and flattening of the scar
  • Scar returning to your normal skin color

Incision site swelling and redness are to be expected in the first few days after the procedure—your surgeon can provide a more precise time frame. However, if this inflammation lingers beyond the expected time period or is accompanied by other warning signs, it’s time to contact your doctor. 

When to Call Your Doctor: Warning Signs

Ideally, your incision will transition from a wound to a scab to a scar, eventually healing completely. But in some cases, incisions don’t heal properly and become infected. Keep an eye out for these infection warning signs and contact your doctor promptly if any of them appear:

  • Redness, swelling, warmth, or pain that persists beyond the expected period without improvement (typically around a week)
  • Oozing pus
  • Odor coming from the incision
  • Fever and/or chills

Infected surgical wounds may be superficial (involving only the skin), deep (involving the muscle and deeper tissue), or go even deeper and affect the spine. The infection depth will impact the proposed treatment plan, although many cases can be resolved with antibiotics. In some cases, surgery may be required to fully clean out the infected wound. 

Managing Incision Pain and Discomfort

Some incision-site discomfort is normal after spinal surgery. Although it should improve within about a week as your body recovers, proper wound care and at-home remedies can help ease your pain. 

Incision care tips to manage discomfort:

  • Keep the incision clean and dry, being careful to avoid submerging it in water until cleared to do so by your surgeon. 
  • Only apply ointments, lotions, or other topicals as advised by your surgeon. 
  • Follow all post-operative instructions for incision care, including attending a follow-up appointment for suture or staple removal. 

At-home remedies to help with incision-site discomfort:

  • Pain medication, as prescribed by your surgeon
  • Cold therapy, making sure to wrap ice packs properly to protect your skin and keep the incision dry
  • Compression bandages may help prevent swelling, fluid accumulation, and discomfort (when used as recommended by your surgeon) 

Products to Avoid on Your Healing Incision

Various topical products can irritate, dry out, or otherwise compromise your healing incision. These include:

  • Lotions and creams, unless recommended by your physician
  • Harsh topicals:
    • Rubbing alcohol
    • Hydrogen peroxide
    • Iodine
    • Antibacterial soaps
    • Other harsh cleansers
  • Chemical sunscreens
  • Retinoids
  • Herbal topicals
  • Perfume, cologne, and other fragrances

When it comes to applying topical products, stick to your surgeon’s recommendations. They may prescribe a topical or recommend a petroleum jelly-based ointment to keep the incision hydrated, which can support the healing process. 

Long-Term Scar Care and Management

Scarring is often a major concern among patients heading into surgery. While scarring is an inevitable side effect of surgery, which requires an incision, long-term care can ensure it fades as quickly as possible. 

These scar care and management tips can help your skin heal effectively after spinal surgery. Keep in mind that these tips should only be implemented once your incision has fully closed and healed, leaving behind a flat scar. This may not occur until months after the procedure. 

  • Protect it from the sun. A scar on your lower back, for example, may often be protected by clothing. But if you’re headed to the beach or pool in a swimsuit that leaves it exposed, apply sunscreen (and reapply every few hours) to prevent UV damage, which can darken the scar. 
  • Try a gentle massage. Gently massaging your scar using circular motions can help keep the tissue beneath the skin flexible, leading to a smoother, softer scar. Clean the scar using a gentle cleanser before massaging it, and apply a few dabs of an unscented moisturizer. Begin with light pressure and gradually increase to deeper pressure (as long as it doesn’t become painful). 
  • Consider silicone gel patches. Once the incision is fully closed and healed, wearing a gel patch over the scar can support healing by creating a hydrating, protective environment. This can help bring down redness and flatten the scar, making it less noticeable. Just make sure to talk to your doctor before applying any new product to the scar, including silicone sheets, and note that they shouldn’t be used on open wounds. 
  • Maintain a healthy lifestyle. Positive lifestyle habits like quitting smoking, eating a nutritious diet, and staying hydrated support your body’s overall healing process, which may help with post-operative wound healing and scar reduction. 

How Long Does It Take For a Spinal Incision To Heal?

It generally takes about two weeks for a spinal incision, including a spinal stenosis incision, to completely heal. At this point, your surgeon will remove sutures and staples, as well as clear you to take baths and swim. However, this timeline can vary from patient to patient. 

Spinal incision infections typically appear two to four weeks after the procedure. Your surgeon will advise you to be aware of infection symptoms, which include fever, worsening redness at the incision, and changes in the infection drainage. If any of these symptoms occur, make sure to reach out to your surgeon immediately.

Additionally, if the surgeon places any hardware or devices during the procedure and an infection develops, they may need to be removed. This also applies to patients with an implantation spinal cord stimulator incision or spinal fusion incision. 

How Long Does It Take For Spinal Nerves to Heal After Surgery?

Immediately after the spinal nerves are decompressed in surgery, the healing process can begin. But, nerve tissue heals far slower than other types of tissue in the body, namely muscle tissue. So, while some patients will experience an immediate improvement in nerve pain after spinal surgery, other patients may need more time to notice a difference. 

In the weeks and months after spinal surgery, patients should notice a gradual improvement in neurological symptoms such as numbness, tingling, and weakness. By adopting healthy lifestyle habits, such as engaging in low-impact exercise, eating healthily, and refraining from smoking, you can ensure that the spinal nerves heal as quickly as possible. 

Spinal Surgery Advances For Smaller Incisions

Surgeons always aim to create as small an incision as possible while successfully carrying out the procedure. This is because a smaller incision leads to less blood loss, less scarring, and a lower risk of infection. 

Fortunately, the last several years have seen a revolution in back surgery procedures and outcomes. Now, more minimally-invasive procedures are available to patients that require spinal surgery. These procedures allow for much smaller incisions, among other advantages over traditional open back surgery.

Spinal Fusion Alternatives

One procedure that can now be replaced with minimally-invasive alternatives is spinal fusion back surgery. This procedure was traditionally performed in conjunction with spinal decompression surgery for spinal stenosis, spondylolisthesis, and related conditions. 

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Spinal fusion involves positioning an implant containing bone graft material in between the affected vertebrae. Over the course of several weeks after the procedure, the bone graft will trigger the fusing of the vertebrae, turning them into a single bone. As a result, the patient can avoid spinal instability after decompression surgery. 

Unfortunately, spinal fusion requires a long recovery period and eliminates the natural movement of the individual vertebrae. It also creates the risk of adjacent segment disorder, or ASD, which occurs when the vertebrae surrounding the fused segment degenerate more rapidly than they otherwise would. 

The TOPS System From Premia Spine

Thankfully, a spinal fusion alternative has emerged to improve outcomes and preserve patients’ range of motion: the TOPS (Total Posterior Solution) System. The TOPS System is an implant that facilitates a minimally-invasive spinal surgery. It’s been shown in clinical trials around the globe to provide superior outcomes for patients who undergo treatments such as lumbar laminectomy or other spinal decompression procedures for various causes of lower back pain. 

As the example of the TOPS System indicates, these advances in minimally-invasive back surgery allow for not only fewer complications in surgical incision healing, but also improved outcomes overall.

Don’t hesitate to discuss concerns surrounding post-op incision care with your surgeon, and make sure to explore all of your spine surgery options.