Question: Is scar tissue really the cause of leg pain?

I had back surgery in 1996 for a herniated disk at the L5-S1 position. Two years later, I had a severe episode of pain in my right calf and the right side of my right foot. The same severe symptoms returned a year later, and they have returned a third time this year. I have been in considerable discomfort for the last 3 months, and I have "twitching" of the muscles on my right calf when I am at rest.

I have been told that my condition is caused by scar tissue at the site of surgery compressing the nerve. My question is, how sure can we be that the problem is really scar tissue? Because of the long period after surgery before I had severe symptoms, and because I overcame severe problems twice in the past, I don't understand how the problem could be scar tissue.

Should my physicians be looking for something else? This year, I have seen an MRI specialist, a neurologist, and a neurosurgeon. Should I be seeing another type of health professional?

Article continues below

Doctor's response: See a spine specialist and consider other conditions

I would absolutely agree with you that the scar tissue is an unlikely cause of your pain. In general, scar tissue is an often over-diagnosed condition and much overrated cause of pain. Moreover, scar tissue would be highly unlikely to develop two years after surgery. If it is going to become a problem, it should become evident within the first several months after surgery, which is when it develops.

There are more subtle causes of pain, such as foraminal stenosis, where the nerve gets pinched as it exits out the spinal canal. This is especially likely to happen at L5-S1, and if you have a lot of disc space collapse on your MRI scan it is a strong possibility. Also, although the scar tissue is not a cause of pain it does limit the motion of the nerve root, and even small herniated discs or other lesions can then be painful.

If you want another opinion, I would suggest seeing a surgeon who is fellowship-trained in spine surgery and for the most part does only spine surgery. These findings are again subtle and sometimes it takes someone who specializes just in spine surgery (either orthopedic or neurosurgeon) to accurately diagnose your condition.

Another thing to consider is that the pain is not from your disc space at all and could be from other causes, such as sacroiliac joint dysfunction or piriformis syndrome. These conditions can mimic the symptoms of a pinched nerve, but require manual therapy and not surgery.

Recommended Articles:

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.