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Could this be scar formation?

AnonymousUserAAnonymousUser Posts: 49,671
edited 06/11/2012 - 8:31 AM in Back Surgery and Neck Surgery
My son (he is 29) had L4/L5 discectomy 3 months ago (his third redo), and is still having severe pain, though not radiating down his legs as before. He has told his NS about his pain, but his NS basically just says he isn't sure what is causing it, but is certain it isn't another herniation and basically tells him to live with it. My son has requested another MRI, but the NS said that his pain symptoms don't warrant another MRI from him. He has referred him to Pain Management.....
He has sharp pains with movement, and just very bad pain in general. His walk is different, and he moves like an elderly person.
It sounds to me (after doing research on the internet), that it may be a scar tissue problem. If it is, can it be treated successfully?
He is unable to work (and he desperately wants to!); and with his back the way it is, who would hire him??? I feel so badly for him; is there any hope??


  • There's actually another post not too far back about this very thing. As it was mentioned on that thread--the only way to know for sure, is to open the area up and look and then clean it out. The problem is that the more you open it up to look, or even fix, it will actually create more scar tissue. It's a catch-22. MRI's can look to be sure that ther isn't a herniation or possible a bone fragment, but it won't typically show scar tissue. He can at least see another NS and get a second opinion for it so he doesn't have the frustration of being "blown-off".
    Good luck! Andrea
  • After my 3rd discectomy I had no relief and was diagnosed with permanent nerve damage. After 1 year I became MUCH worse. The discs had collapsed in the areas where I'd had multiple surgeries and bone was pinching nerves. I've had a fusion and I don't walk like a elderly person anymore! THERE IS HOPE! I would think if it's scar tissue, the NS would have addressed that during surgey. I'm not really sure how quickly scar tissue can build up. Nerves take a long tome to heal, the longer it's been pinched, the longer it takes. He might just need more time. I would definitely get a second opinion though!!! I've had many doctors be wrong about my issues, if I'd listened to them I'd be in a wheelchair. Follow your gut, if it doesn't feel right, it isn't right.
    Faith M
  • He is very frustrated, and very depressed; the pain is affecting his entire life, and his NS does not seem concerned (I know; I've been to his follow-up appts. with him). He is being referred to the Physical Medicine and Rehab department, but can't get seen until mid-June. Till then, he is on his own. And in a lot of pain.
    The way the NP explained why the NS feels this way, is that his job is to remove the herniation. Once that is done, and the removal is successful, the surgeon's job is done. He can do no more. My son did not "qualify" for another MRI because his pain is limited to his back, and is not down his leg as before the surgery.
    If what his NS said is true, then wouldn't another NS tell him the same thing??
  • I think I was the one who started the more recent thread that alcb mentioned,...anyway. Scar tissue can be discernable on an MRI with contrast and sometimes on a T2 weighted image (hyperintensive material). Surgeons have their egos attached to their work to a certain degree and are hesitant to look for "failed surgery" reasons in my opinion. Definitely get a second opinion with a highly recommended neurosurgeon in your area. Ask your family doctor who they would have work on them if they had a spinal problem.

    There are ways to treat scar tissue from what I've been researching. First of all,...many will say,..if you have another surgery to remove the scar tissue it will just come back. That is possible but it could regrow differently and not around the nerve root or spinal cord itself. If the surgery is repeated using a catheter and a "laser", the results, from what I have read, are pretty favorable. There is also a technique using "radiation" in the area 24 hours before surgery to limit the inflammation fibro response in that area. Another procedure is called "Lysis of Adhesions" using a chemical that softens and deteriorates fibrosis. Also,...in PT "Nerve Glides" while stretching the hamstring aids in keeping the nerve mobilized so the scar tissue doesn't trap the root. There are also "systemic enzymes" that I have read about which from a nutritional/supplemental standpoint are supposed to minimize fibrosis throughout the body. Not sure about how effective that really is.

    Now, having said all that, if your son is not having ANY leg symptoms like tingling/numbness/pain, it doesn't sound to me like he is having a nerve root encased with scar tissue. I'm not a doctor though. I am just basing this on personal experience and research info.

    I think a second opinion is a good idea. :)

    Good Luck
  • any update on a possible second opinion or new gameplan?
  • If I were you, I would find a fellowship-trained orthopedic spinal surgeon and make an appointment for a consultation. At least from my experiences, and, anecdotally, from what I have learned from others, orthos have a slightly different attitude and approach to treatment. Just be sure you locate one whose practice is devoted to issues of the spine and back, not joint replacement, other parts of the body, etc. His fellowship training should be in the Spine.

    It seems that your son's NS has lost interest in your son's case. As another poster said, he has done his work. As far as he is concerned, the work was done properly and now it is time for you son to move on. They only make money when they are operating. ;) It doesn't hurt to go to an interventional pain management doctor. She or he can provide some relief for your son's pain.

    I agree that it does not sound like a problem with a nerve since your son is not having symptoms of "sciatic" pain.

    Please be aware that scar tissue is a natural part of healing. It is the body's way of covering a wound or of filling in a space when something has been removed. Most times it is not a problem. But when it grows back in a random pattern and ends up wrapping around or pressing up against a nerve, it begins to cause problems, pain, etc.

    After three surgeries, your son is bound to have lots of scar tissue...but it may be inert and not causing any problems.

    Your description of his pain sounds to me more like a mechanical pain. It may be that a fragment of the disc has broken loose, or he may be down to "bone on bone" at that L4-5 level from having three discectomies.

    Have him find another spinal specialist! He needs to keep pursuing this. From what you've described, it doesn't sound like a very complex problem...he just needs to find the right doctor who can help him!!
  • Your son has had a lot of work done on his back and those nerves each time are messed with and then need to re-grow the whole length of the nerve. (1 inch a month) That is the job of the NS to take out what is wrong and then really they can do no more. They unfortunately do not provide much moral support during the healing time.
    I would call again to the place where he can't get in until June and keep calling to see if there are any cancellations. Did his doctor's office set up the appointment or did he call. They usually have more pull in getting quicker appointments.
    Is he doing mild exercises? Is he walking? I have gone through those surgeries myself except I have had one more which was fusion. I do understand the frustration and the depression. I was also fortunate to have a surgery that removed scar tissue where it had formed and had L5 and S1 nerves trapped and now that part is great, but that showed up on a myelogram as something wrong.
    He needs to be proactive and keep asking for what he needs and reaching out for information that might help him improve. I have used an Osteopathic doctor throughout my entire recovery and he has gently stretched muscles and tissue to keep thing in alignment. I would not be where I am today had it not been for him.
    I love a heating pad and that provides much relief to me. Some would say ice too, but that is not helpful to me.
    Keep trying, there always is hope.
  • For the scar tissue removal surgery, did they use a laser or use a cobulating tool? I'm glad to hear that it worked for you. This is a procedure I may need to have is why I ask.

  • Buckeyeback,

    I am sorry but I don't really know what my NS did other than take his time and cut away the scar tissue to free my L5 and S1 nerves. I really feel that the nerves got caught up in the scar tissue because of the brace I had for 3 months and the lack of movement. The radiologist saw a piece of something at S1 and this is why my NS went back in for the fourth time.
    I see you have had 3 ESI's. My doctor didn't want those for me cause he said they will just make more scar tissue where there already is too much.
    What you wrote about what the radiologist and the surgeon saying it is something else is exactly what was my situation. I told my surgeon there is something wrong and he helped me. The best words afterwards that came from his mouth were "you were right, the nerves were scarred...." Thank goodness that I have a trusting relationship with him. Where others have had problems with their surgeons I have been so grateful that mine has been so supporting throughout the whole time.
    I hope you can get help. It is the worst feeling knowing in your body that something is wrong and trying to convince someone to help you.
  • I'll keep after them. This latest ESI hasn't really helped at all. Usually (presurgery) it helps immediately. Not this time. Straight leg raise test is negative so I tend to believe it is scar tissue. I won't live this way (it's not living) and my surgeon said he would go back in to find out what is wrong if this ESI and PT don't help. So we'll see.

    Thanks for responding. :) Glad to hear you beat the scar tissue.
  • 2nd opinion. Sometimes a fresh set of eyes see something a previous professional did not. Has a neurosurgeon always done your son's surgeries? If so, look for a fellowship trained board certified orthopedic spine surgeon. Sounds to me like he needs to see one while there is still a possibility of anything that can be done getting done.

    Scar tissue surgeries? I don't know a lot about those being successful but I do know the more you mess in there with epidurals, surgeries, whatever, the more you create.

    Is your son in physical therapy? Can be an excellent way to document frequently his symptoms and I do believe in manual scar tissue for superficial scar tissue and freeing up the fascia to move.

    But my main thing is I would go for a 2nd opinon. The NS doesn't even have to know if you go outside of his practice(which you should.) Your son is way too young and this is way too much for him to go through.
  • ernurse said:
    2nd opinion. Sometimes a fresh set of eyes see something a previous professional did not.

    But my main thing is I would go for a 2nd opinon. The NS doesn't even have to know if you go outside of his practice(which you should.)
    I agree. Get a 2nd and even a 3rd opinion if need be.

    As far as the 1st surgeon not knowing. Don't assume that. The 2nd surgeon will want to get copies of your files from the 1st surgeon to see what has taken place. Including all the surgical notes. You would have to tell the 2nd surgeon specifically that he can't contact the 1st one. I personally wouldn't do that. When I went for the 2nd opinion I had the 2nd surgeon get all my records from the 1st one. I told the 1st that the insurance company needs at least 2 opinions before they will approve any other work. Keeps it simple and doesn't create an issue with the 1st surgeon or the 2nd. They both get to believe the insurance company is the bad guy. Serves its purpose.

    The 2nd surgeon had a different opinion of what should have been done. Not drastically. Not bad mouthing the 1st one. 1st was an ortho and 2ns was a neuro. I don't think one is really any better than the other. At least not so far.
  • I am dealing with scar tissue problems and it was found around 9 months post op after my fusion. My surgeon thinks doing surgery isn't a good idea because he fears it will grow back worse. I have read that if a person does well post op, and all of a sudden gets worse that it could be scar tissue forming and causing problems such as impinging or wrapping around a nerve. There is a lot of different opinions about whether or not scar tissue is the cause of pain, and it depends on your doctor how he wants to treat it. I personally have decided not to mess with it and I'm hoping that a morphine pump will control the pain. I also agree that a 2nd or 3rd opinion would be of great help. Take care
  • I have had two I'd say "unsuccessful" discectomys, with no option for a third. If I was given that option I'd tell them to piss off. I am 10+ weeks out from my last surgery, and I am in worse pain than before. If anyone has scar tissue I guess it would be me since having 2 surgeries so close together. They said during the second surgery they removed some scar tissue, but how can I be sure...I was a sleep. My leg pain is not the same as before the surgery, but I am still having leg pain and weakness when I stand/sit. Tons of back, thigh, and buttocks pain (like getting shocked by a 220 volt outlet every now and again with the constant burn/ache). I walk like an old man...hobbiling along in severe pain now. Can barely get through my days of being confined like a prisoner in my own home since obviously I can't work in so much pain. My Doctor said I would probably need a fusion "someday" and he wants to put it off for as long as possible since I am only 32. To top it off, every once in awhile I can feel/hear my spine move/shift/grind at the location of my surgeries where "I know" I have no disc left (possible "Abnormal micro motion instability from DDD) like never before (not typical back popping sound), and I am starting to doubt my Doctor. Tell your Son he is not alone. I hope he and I will get through this and be better in the end. Keep us posted on the outcome. :H
  • I posted my story when I answered someone else alwhile back. It kinda pertains to your question in away. You can take it for what it's worth. As to why I agree with others you don't always want to take one doctors word for anything!

    If you want the link I will find.

    I had the same problem. L5 S1 Micro. surgery done and still had pain. Doc insisted that it was scare tissue from second MRI and needed time to heal as scare tissue reseads over time. I started PT but also stopped taking my pain meds in fear of addiction but continued to complain about the pain.
    Then after three months the pain got so bad I started all my pain meds back up, I stop going to work, and insisted to the doc something still was not right! He finally ordered a EMG and when I went for that test they told me the nerve could still be pinched. The doc who tested me told me my Spine doc would probable need to correct by surgery.
    Well! This is where it gets interesting.
    When I went back to the doc and told him what the EMG doc said the doc then said he would review the results. After another week I get a call from my spine doc and he told me he needs to open me back up and see what he can find wrong.
    Well, they did! He went back in and said he found a few small bone pcs. but nothing that would cause the pain I had. Then just as he was about done he said he found 1 huge pc. That finally made its way to the nerve point. And that is what finally put me out of commission.
    Well, now I'm recovering for the second time.
    Don't let the doc tell you its scare tissue or that the nerve needs time to heal. If the emg showed still pinched and the pain continues to get worse I would insist the doc open your son back up and do Clean-up where the EMG showed the nerve to still be pinched. If a foreign object is rubbing against that nerve for a long time then he will have nerve damage.
    If I wouldn't of had the emg doc tell me my spine doc would probably need to repair me to correct I would still be out of commission on major pills. Because my doc would still want to see if the nerve needs time to heal.
    If you don't feel relief after Mirco surgery there is something still wrong. Exspecially if the pain is getting worse.

    It's ok to see other doctors. You don't have to take what this one said as set in stone. Seek other opinions from maybe a Ortho instead. I would ask what others say.

    Here is a question for your son.. Is there times when the pain almost feels like a jolt or shock type twinge? Or is his pain more like a normal hurting pain.

    Example: if he roles over in bed is there times where even though it's painful does he get a jolt type pain down the low back and leg. Or if he bends a certain way does he produce that same jolt pain. The jolt pain I refer to is a different pain then what he feels in his butt or calf. This is bend over tears type pain that only last a second or two then back to normal pain.

    I ask because that extra jolt is what happen to me. It felt like the nerve would get hung up either by scare tissue or bone then snap when it was able to freely move. Like a rubber band. Which to me is what caused that bad sentation.
    Now after my 2nd. I don't get that jolt pain anymore. So for me there was a difference when I had the bone pcs. and extra scare tissue involved.

    Hope this helps.

  • I just read your post also. Your post/issues sound identical to what I had. Dude no joke! I originally posted on this site to let others know what happened to me because before I had that corrective surgery I thought I was going to loose my mind.
    To this day I think about how things would have been if the lord didn't help the doctor find that pc before he closed me back up that second time.
    My opinion and it is just an opinion. I think you might have something still in there and unless that doc was looking in that area he could operate 10x and not find anything.
    Did you have a EMG test?
    To both! Hang in there! It's hard but you have to stay positive to proceed with life. For you and your loved one's!
    God bless!

  • I know exactly what you're talking about. Mine just happened once and I thought I herniated a disc that had been "shaved." You can see below what the opinions were of what had happened. Haven't had it since, but still have pain in the hip and top of foot along with some numbness on the bottom of my foot. Had an ESI Friday and the tingling has diminished but everything else is still there. Surgeon said he would go back in if things don't get better soon....We'll see. I sure don't want to go through this all over again.
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