Scar Tissue and Continued Pain After Back Surgery

Scar tissue formation is part of the normal healing process after a surgical intervention. While scar tissue can be a cause of pain, in and of itself it is rarely painful, since the tissue contains no nerve endings. Rather, the principal mechanism of pain is thought to be the binding of the lumbar nerve root by fibrous adhesions, called epidural fibrosis.

These fibrous adhesions are a common occurrence after spine surgery, and occur for patients with successful surgical outcomes as well as for patients with continued or recurrent leg pain and back pain. For this reason, the importance of scar tissue or epidural fibrosis as a potential cause of continued pain after surgery is controversial.

One common occurrence is when a patient still has pain postoperatively and the only remarkable finding on a new MRI scan is that there is now scar tissue. It may therefore be assumed that the scar tissue is now causing the patient’s pain. However, if the patient’s pain feels the same as it did preoperatively (and there was no scar tissue at that time) why is it now assumed be the cause of the patient’s symptoms? It is far more reasonable to assume that the original cause of the patient’s pain was not addressed by the surgery.

The one time that scar tissue (epidural fibrosis) may be symptomatic is for a patient who initially does well after a discectomy or a decompression, only to have recurrent pain come on slowly between 6 to 12 weeks after surgery. This is the time period that scar tissue takes to form.

Pain that starts years after surgery, or pain that continues after surgery and is never relieved, is not from scar tissue.

• Article written By:
• Peter F. Ullrich, Jr., MD

January 28, 2003

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