The formation of scar tissue near the nerve root (also called epidural fibrosis) is a common occurrence after back surgery—so common, in fact, it is so common that it often occurs 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 (epidural fibrosis) as a potential cause of postoperative pain—commonly called failed back surgery syndrome—is controversial.

Scar tissue formation is part of the normal healing process after a spine surgery. While scar tissue can be a cause of back pain or leg pain, in and of itself the scar tissue is rarely painful since the tissue contains no nerve endings. Scar tissue is generally thought to be the potential cause of the patient's pain if it binds the lumbar nerve root with fibrous adhesions.

Examining other Causes of Pain after Back Surgery

If a patient suffers from continued back pain and/or leg pain after discectomy or laminectomy surgery, a comprehensive physical examination and appropriate diagnostic imaging techniques can often pinpoint the cause of pain. In addition, there are a few things that can be done before and/or after spine surgery that have the potential to limit the formation of scar tissue over the operative disc.

About 200,000 lumbar laminectomy and discectomy (microdiscectomy) surgeries are performed every year in the United States. Approximately 90% of these surgeries will result in a good outcome. For the remaining 10% of patients who do not do well after spine surgery, the search for a solution to their continued pain begins with an assessment of the likely cause of that back pain or leg pain.


Clinical Profile of Epidural Fibrosis

Typically, symptoms associated with epidural fibrosis (scar tissue around the nerve root) appear at 6 to 12 weeks after back surgery. This is often preceded by an initial period of pain relief, after which the patient slowly develops recurrent leg pain or back pain. Sometimes, the improvement occurs immediately after back surgery, but occasionally the nerve damage from the original pathology (cause of the patient's pain) makes the nerve heal more slowly.

In general, if the patient experiences continued leg pain or back pain directly after spine surgery, but starts to improve over the next three months, he or she should continue to improve. If, however, there is no improvement by three months postoperatively, the spine surgery is unlikely to have been successful, and the patient will continue to have back pain or leg pain.

It should be noted that failed surgery and condinued leg pain after a spinal decompression surgery (a laminectomry or microdiscectomy) is much more likely to be from other factors (e.g. a missed diagnosis, recurrent disc herniateion, battered nerve root, etc...) than from scarring around the nerve root. This topic is covered in more detail on the next page.

Dr. Peter Ullrich is an orthopedic surgeon who retired from practice with more than 20 years of experience specializing in spine surgery. Dr. Ullrich previously practiced as an orthopedic spine surgeon at the NeuroSpine Center of Wisconsin.