Other considerations for failed back surgery syndrome

When scar tissue is not the cause of pain

If the recurrent pain appears years after spine surgery, it is unlikely that the pain is due solely to scar tissue. Scar tissue does not continue to form years after spine surgery, so it is generally not considered a cause of late recurrent pain. Rather, the nerve may be compressed, or “tethered”, by a small disc herniation or by new bone growing near the nerve (stenosis).

The clinical presentation of a tethered nerve includes a positive straight leg-raising test (i.e., lifting the leg causes increased pain down the leg). In such cases, repeat decompression or discectomy surgery will usually lead to good results.

If there is postoperative leg pain with no evidence of nerve tethering, simply removing the scar tissue is unlikely to do any good. This conclusion is due to the fact that scar tissue is an uncommon cause of postoperative pain and that scar tissue tends to form again after repeat spine surgery.

Scar tissue versus other causes of pain after surgery

Scar tissue can lead to postoperative leg pain by binding the nerve root. Although the growth of scar tissue can be limited with interpositional membranes, this has not been conclusively shown to lead to better clinical outcomes. Other causes of continued or recurrent leg pain should be sought prior to settling on epidural fibrosis or scar tissue as t he cause of the patient’s pain following a back surgery.