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Five years ago, I had a disc removed and fusion of the L45 spine. Now, I'm getting ready to do it again only this time at the L34 area. Will they use the same scar from the previous surgery and just extend it up? Or do they start over with a fresh incision? Anything new in the way the operation is done these days?

This would be a good question to ask your surgeon. Usually, the surgeon wants to gain access directly over the area being operated on. This pathway down to the L34 spinal segments is called the surgical corridor. Making an incision at that level is most likely the way it will be done. Every effort is made to avoid cutting into muscles, tendons, ligaments, and other soft tissues whenever possible. As a result of studies published on this topic, surgeons have started to adjust the way this procedure is done. For example, the procedure was originally done using an incision along the middle of the spine. But this midline approach cut through an important spinal muscle (the multifidus). Muscle weakness resulted in loss of function of this important spine stabilizer. Surgeons started making incisions on either side of the spine in order to avoid cutting the attachment of the multifidus muscle to the spinous process. The spinous process is the bump you feel along the spine, often referred to as your "back bone". A second change that has come about is the use of tubular retractors used to hold the soft tissues apart after the incision is made. The retractors are attached to the table. There are two advantages to this tool: 1) a surgical assistant no longer has to hold the retractors steady for the entire length of the operation and 2) pressure on the soft tissues, nerve, and blood vessels can be minimized. These new table-mounted retractors are a great improvement over the self-retaining retractors used before. During long periods of retraction, pressure from the table-mounted retractors can be released from time to time. This feature reduces force and load on the muscles and tendons and helps maintain good blood supply to those areas. With shorter retraction times and periodic release of pressure, there are also fewer nerve injuries contributing to muscle weakness.

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