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.
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.
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.