It must be kept in mind that postoperative imaging studies will almost always show scar tissue involving the nerve root and surrounding structures, a phenomenon known as the post-laminectomy membrane. Much clinical and animal research has been done on the nature and significance of this scar tissue, but it has not been conclusively shown that scar tissue is a major cause of back pain or leg pain after spine surgery.
Techniques Used During Back Surgery
Fat grafts taken from the wound, gelatin sponges, silicon-based sheets (Silastic) and other techniques have been used in an effort to block the mobilization of cells into the region of the nerve root, thereby inhibiting development of epidural fibrosis. Although animal studies have shown that these ‘interpositional membranes’ do indeed limit the formation of scar tissue, the technique has not been conclusively shown to improve clinical outcomes.
Stretching Exercise After Back Surgery
Stretching the nerve root while the body is healing (scarring in) after back surgery can help limit epidural fibrosis from becoming a clinical problem. Most scar tissue forms within the first 6 to 12 weeks after back surgery. The theory is that if the nerve is kept mobile while the wound heals, the nerve will not be bound down by adhesions and the scar tissue that develops should not become a problem. For example, routinely pumping the ankle while stretching the hamstrings, the large muscle running down the back of each thigh, will move the nerve across the operative disc site in the low back and help prevent it from scarring down.
When Back Pain is due to Scar Tissue
If a complete physical exam and diagnostic imaging indicates that the patient’s back pain or leg pain is due to a nerve root bound by scar tissue, the treatment options are fairly limited.
- In the early postoperative period (3 to 12 months), medications such as Neurontin may help limit back pain or leg pain, and exercises can help free up the nerve.
- Beyond this time period, pain management techniques may help the patient cope with the back pain or leg pain.