# Aesthetic-Cosmetic Concern and Its Importance: A Questionnaire-Based Comparative Study of Posterior-Midline and Postero-Lateral Scars in Lower Back Surgery

## TL;DR

This study compares patient preferences for different types of surgical scars on the lower back and finds that midline scars are generally preferred, but patient education about minimally invasive techniques can shift preferences.

## Contribution

The study provides new insights into patient aesthetic preferences for surgical scars in lower back procedures and highlights the impact of education on these preferences.

## Key findings

- Midline posterior scars were preferred by 76.69% of participants over postero-lateral scars.
- Learning about minimally invasive techniques caused 45.42% of participants to switch preference to MIST scars.
- Lumbar spine scars were of less concern compared to scars in other body areas.

## Abstract

Introduction

Literature concerning the aesthetic appeal of incisions following minimally invasive spine surgery is sparse. We aimed to address this gap in the literature and to understand the cosmetic preferences of patients with respect to the postoperative scars after spine surgery.

Objectives

This cross-sectional study aimed to identify patient preferences and aesthetic concerns related to surgical scars in MIST (minimally invasive transforaminal lumbar interbody fusion (TLIF)) and SOST (standard open surgical TLIF).

Methodology

A cross-sectional questionnaire-based study was conducted among people visiting an outpatient spine clinic to compare the aesthetic preference of patients. The study included 399 participants, with an age of 33.58 (12.82) years, consisting of 229 females and 170 males. The responses to the questionnaire with illustrative scars were analyzed with descriptive statistics to arrive at a conclusion.

Results

Among the participants, 238 expressed aesthetic concerns about scar appearance. A total of 153 (38.3%) respondents were more concerned about a scar on the back when compared to scars elsewhere on the body. A total of 306 (76.69%) individuals preferred the scar of surgical midline posterior TLIF (SOST) while 93 selected the MIST scar (p < 0.001). Notably, 139 of these participants (45.42%) changed their preference to MIST scars (p < 0.001) upon learning about the advantages of the modern MIST technique.

Conclusions

Patient-oriented aesthetic outcomes in surgery are essential. However, a lumbar spine surgical scar is of less concern than scars elsewhere on the body. Midline scars were noted to be more aesthetically pleasing than paramedian scars. Counselling regarding the advantages of modern minimally invasive techniques, however, can improve patient acceptance of the procedure despite the scar. Addressing patient concerns about scar appearance, psychological impact, and social implications should be integral to surgical decision-making and postoperative care.