Back Surgery Scar Tissue

by admin on March 11, 2011

After surgery for spinal stenosis it is common for scar tissue to form and this can cause complications in some cases leading to failed back surgery syndrome.  Failure of back surgery to improve a patient’s condition is, however, not usually due to scar formation with the culprits more likely to involve recurrent disc herniation, permanent nerve damage prior to surgery, or a misdiagnosis.  As some patients with scarring experience no recurrent symptoms the effects of epidural scarring remains controversial with some researchers finding no significant differences between outcome in patients with or without post-surgical scarring (Rönnberg, et al, 2008).

Scar Tissue From Surgical Error

Scar tissue can however, be a result of surgical error and may lead to complications such as further leg or back pain.  If the scar tissue impinges upon the nerve root it is referred to as peridural fibrosis and may require a further operation to remove the scar tissue.  The success rate of spinal surgery diminished with each further surgery in most cases making the first operation extremely significant in terms of predicting long-term patient outcome.  Most scarring will occur within the first three months of surgery, although fibrosis has been observed in half this time.

Coping with Back Surgery Scar Tissue Pain

Some exercises can help to reduce the extent of peridural fibrosis after spinal stenosis surgery and are often beneficial in reducing back and neck pain.  Regaining mobility quickly after surgery can limit the opportunity for scar tissue to form around the nerve and walking and non-weight-bearing exercise is recommended for most patients by their physician after their operation.  By stretching out your lower limbs, such as hamstring stretches and ankle rotations, the nerves in the lower back are kept active.  This means that fibrous scarring is broken up and flexibility is improved.  Exercising in moderation is important as any sudden, excessive movements may exacerbate the condition and lead to further scarring and injury.  If you have had spinal stenosis surgery on the thoracic spine or upper back then gentle arm stretches can help to keep the spinal nerves functional and reduce scarring opportunity.  Start with a gentle across-body arm stretch, taking care not to strain too far, and increase the stretch each day to improve flexibility.

What is Scar Tissue?

Scar tissue itself is not necessarily problematic as it is the body’s natural response to trauma such as tissue excision.  The fibers of scar tissue contain no nerve endings themselves and do not transmit pain.  Instead, it is the adhesion of the fibrous tissue to the nerve roots that lead to pain and dysfunction.  Pain is usually relieved after spinal stenosis surgery and peridural fibrosis may begin to develop between six and twelve weeks after your operation with recurrent leg or back pain occurring.  Sometimes the improvement in your condition is slower, especially where significant trauma to the spinal nerves has occurred over a longer period of time.  As the nerves begin to heal peridural fibrosis may occur, resulting in little or no relief in your back pain after surgery.  If signs of improvement begin to show over the first three months after surgery then improvements will usually continue.  If no improvement is experienced after three months then the outcome is usually poor for pain reduction.

Back Surgery Scar Tissue

Scar tissue forms naturally as a body defense

Medication for Scar Tissue Pain

Different drugs have been investigated to determine their efficacy in preventing post-spinal-surgery scar tissue formation although none appear particularly successful.  A study in 2008 by Suat, et al, found that the application of an antibiotic called mitomycin C at the site of discectomy had no effect on fibrosis (scar tissue formation) in the treated patients despite it being used  with some degree of success in veterinary surgery for animals undergoing laminectomy.  Further study of the drug is expected with alterations in the duration and method of application, and the strength of medication used.  Other methods to reduce fibrosis include the use of mesh inserts during surgery, autologous fat transfer, and an anti-adhesion barrier gel ADCON-L manufactured by Gliatech Inc.  Varying degrees of success have been found using these techniques, although, as mentioned above, the correlation between scar formation and recurrent symptoms is far from straightforward.  Ozer, et al (2006) found that preserving the ligamentum flavum during a lumbar discectomy meant that significantly less scarring occurred in comparison to excision of the ligamentum flavum as traditionally done in the procedure.  Clinical guidelines in some countries have, therefore changed as a result of these findings in order to minimize fibrosis.

Therapy for Scar Tissue Pain

Stretching, massage, strengthening exercises, and physical therapy are all good options to help reduce the incidence of peridural fibrosis.  These therapies can increase strength and flexibility but may be prescribed alongside NSAIDs, or spinal steroid injections to reduce inflammation and pain if physical therapy alone is insufficient to reduce symptoms.  Laser spine surgery may also be a minimally invasive option to remove scar tissue that has become problematic.  Surgery is usually the last resort, however, and should not be relied on as a guaranteed method of pain reduction.


References

Ozer AF, Oktenoglu T, Sasani M, Bozkus H, Canbulat N, Karaarslan E, Sungurlu SF, Sarioglu AC., (2006), Preserving the ligamentum flavum in lumbar discectomy: a new technique that prevents scar tissue formation in the first 6 months postsurgery, Neurosurgery. 2006 Jul;59(1 Suppl 1):ONS126-33.


Rönnberg K, Lind B, Zoega B, Gadeholt-Göthlin G, Halldin K, Gellerstedt M, Brisby H., (2008), Peridural scar and its relation to clinical outcome: a randomised study on surgically treated lumbar disc herniation patients, Eur Spine J., Vol.17, No.12, pp.1714-20.


Suat E. Çelik, MD, et al., (2008), Mitomycin Protection of Peridural Fibrosis in Lumbar Disc Surgery, Journal of Neurosurgery: Spine, Vol. 9. No. 3. ppp. 243-248.

{ 9 comments… read them below or add one }

Joyce Angell March 15, 2011 at 11:14 am

Once again, I thank you for putting a ‘name’ to my back problem -”peridural fibrosis”…I’m not sure this condition can be helped, I think I’m to far gone for improvement. I can only say “God please continue to help me in my daily routine” – which is minimual, however, I refuse to give up!!!!
Many thanks again,

Joyce Angell

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Mark benoit March 19, 2011 at 9:31 am

Which surgical errors result in scar tissue?

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Kyle April 1, 2011 at 7:01 am

No matter what the problem is, I believe stretching every day even several times during these days can help prevent problems. My father did receive minimally invasive spine surgery as a recommendation from many consultations as a last resort. He stretched everyday, and continues to stretch everyday after the surgery and he has recovered well. Some things are inevitable, but it is how we cope and solve these problems that useful for future knowledge.

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Cliff Butler April 4, 2011 at 4:35 pm

A great article for people disillusioned after what they were hoping was an end to their back pain.
As an Osteopath we see such cases on a daily basis and find that providing people with the how, what and why can help afford some relief. Your article will help us provide patients with some direction.

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Mary Bush July 20, 2011 at 8:23 am

Great post. This is an interesting post. I agreed that spinal stenosis can cause complications in some cases leading to failed back surgery syndrome. I already experienced the back surgery and it is really hurt. I suffer the pain for almost 5months. Thank you because I really enjoyed reading your post. Keep it up.

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Warren38 October 28, 2011 at 3:26 pm

Did your Neurologist do an EMG yet to see if a neural is being pressurized in your hands or leg yet. I would also obtain a Orthosurgeon or Neurosurgeon to see what their cure is and can let you know if it`s necessary to have surgical procedures. Get more than one viewpoint and trust you may obtain a Dr. to help soon.

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Sharon February 15, 2012 at 5:08 pm

I had back surgery in ’04 and have extensive scar tissue that has adhered to all my nerves causing pain in my legs, hips and rib cage and beyond. I am going to be trying spinal cord stimulation and I am excited to see if it will work. Has anyone had this done?

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stanley huneycutt August 9, 2012 at 10:10 pm

i had a neuro stimulator put in aftewr 2 disc removable surgerys . i didnt need any pain meds even after having the stimulator implanted for two months then the pain started its way back . i was a high rise ironworker that worked hard my whole life and tried to stay active , i did therapy and did home therapy plus yard work and little league for two kids and being vice president i was active what all the doctors want but after the stimulator impantation i thought i could go on but it strated slacing off . now i get 30 % releif but that makes a difference . they implanted the stimulator next to my spine which was a terriable place . at night while sleeping on my back it felt like it was being shoved against my spine so i had it relocated and the put it right over my kidney so at times i dont know if im having a kindey infection or if the area around the stimulator is imflamed . make wise choices and get a lot of opinions and one last thing if a Dr says hes one of the best or brags walk away , if they have to brag then they are not confident Dr to work on my back . i had the easyiest job after getting out of ironwork in 1993 and now i cant even work at that job . you worked when you wanted and its pay was very good with retirement benefits and because of one wrong decision its all gone . bgood luck

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john pennington July 25, 2012 at 7:11 pm

I had my first lowe lumbar back surgery in 1972. Most of my muscles had to be cut in order to reach my herniated disc, which had ballowed toward my stomach. This old technique has been a back killer for me. I have had three more surgeries using modern techniques. I have lived with constant back pain, since 1972. I am now told I have scar tissue that has formed in the right side muscles of my back and spine. I have taken a bath tub of pain killers and muscle relaxers. Tens units and PT are of no help. They are afraid to attempt to remove my scar tissue as the outcome has not been favorable. Am I stuck for the rest of my life???????

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