Scar tissue and pain after back surgery
Scar tissue formation is part of the normal healing process after a spine surgery. While scar tissue can be a cause of back pain or leg pain, in and of itself the scar tissue is rarely painful since the tissue contains no nerve endings. Rather, the principal mechanism of back pain or leg pain is thought to be the binding of the lumbar nerve root by fibrous adhesions.
If a patient suffers from continued back pain and/or leg pain after discectomy or laminectomy surgery, a comprehensive physical examination and appropriate diagnostic imaging techniques can often pinpoint the cause of pain. In addition, there are a few things that can be done before and/or after spine surgery that have the potential to limit the formation of scar tissue over the operative disc.
About 200,000 lumbar laminectomy and discectomy (microdiscectomy) surgeries are performed every year in the United States. Approximately 90% of these surgeries will result in a good outcome. For the remaining 10% of patients who do not do well after spine surgery, the search for a solution to their continued pain begins with an assessment of the likely cause of that back pain or leg pain.
Clinical Profile of Epidural Fibrosis
Typically, symptoms associated with epidural fibrosis appear at 6 to 12 weeks after back surgery. This is often preceded by an initial period of pain relief, after which the patient slowly develops recurrent leg pain. Sometimes, the improvement occurs immediately after back surgery, but occasionally the nerve damage from the original pathology makes the nerve heal more slowly.
In general, if the patient experiences continued leg pain directly after spine surgery, but starts to improve over the next three months, he or she should continue to improve. If, however, there is no improvement by three months postoperatively, the spine surgery is unlikely to have been successful, and the patient will continue to have back pain or leg pain.
A comprehensive physical examination and appropriate diagnostic imaging techniques can often pinpoint the responsible pathology. For instance, a definitive diagnosis of recurrent disc herniation or other disorders may be made. In a number of cases, however, an MRI scan reveals only the presence of scar tissue as a remarkable finding, suggesting to some clinicians and researchers that the scar tissue is the likely source of the continued back pain and/or leg pain after spine surgery.
The use of acupuncture to "break up" the aberrant scar tissue is sometimes successful and our experience has been that we can relieve most of the pain in 50% of cases. In many cases, complete relief has been achieved.