Pinched Nerve, Scar Tissue, and Accurate Back Pain Diagnosis

Question:

I had a laminectomy to fix a herniated disk located at L4/L5. The fix only lasted about 4 days before significant pain occurred. I had a second laminectomy surgery two months later where the doctor cleaned up some fragments and increased the amount of the prior surgery. That also did not work.

After a myelogram and a CT scan, the problem appears to be scar tissue which is impacting the L5 nerve root. The doctor is somewhat hesitant to operate again for fear that the scar tissue will reappear.

Do you have any thoughts on how to remove or dissolve this scar tissue? Also, should I be exercising to loosen the scar tissue or passive to avoid making it worse? I am currently taking 1800mg of Neurontin daily as well as 120mg of Oxycontin. Would an epidural steroid injection be of any help?

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Doctor’s response:

If surgery for a pinched nerve does not work, or works only very briefly, then the majority of the time the problem is not scar tissue but something else that is causing your pain.

Scar tissue is a way overrated cause of pain, and does not need to be removed. It does not cause pain in and of itself, although it can tether the nerve root and cause pain with motion. For this reason, you should be in physical therapy working on nerve root mobilization exercises.

If the surgery did not work, then you may need a more accurate diagnosis as to what is the cause of the pain. It could be soft tissue related (e.g. piriformis syndrome) or from a painful motion segment (degenerative disc disease).

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In Spine-health’s Doctor Advice section, physicians respond to frequently asked questions about back pain issues. These responses represent the opinion of one physician, and do not necessarily reflect the views of the broader medical community. The advice presented has not been peer reviewed by Spine-health’s medical advisory board.