Effects of scar tissue on back pain and leg pain
When scar tissue forms near the nerve root, it’s called epidural fibrosis. Epidural fibrosis is a common occurrence after back surgeries. This is so common that it often occurs in patients with both successful surgical outcomes as well as patients that continue to have the leg and back pain they felt before the surgery. Keeping this in mind we can understand why the importance of scar tissue as the potential cause of postoperative pain is controversial. This is commonly referred to as failed back surgery syndrome.
When our body goes into repair mode, scar tissue formation becomes part of the normal healing process after any traumatic injury. Although scar tissue can be the cause of back pain or leg pain, because it does not have any nerve endings, the scar tissue in itself is not painful. The binding or “tethering” of the lumbar nerve root by the fibrous adhesions is the main factor in the back pain or leg pain.
The term pinched nerve refers to the pain or impaired function of a nerve that is under pressure. Nerves that control muscle movements or relay sensations to the brain are usually affected.
Tingling, numbness, burning sensations or shooting pains down the buttocks and leg or in the fingers arms neck and shoulder are the initial symptoms of a pinched nerve.
Sometimes the pains and sensations are distant from the point of pressure. For instance, a pinched nerve in the low back may cause pain in the calf as the only symptom. When there is nerve damage from constant pressure, pain and weakness may increase. There may be a loss of reflexes, movement skills, sensation in the affected area, and withering (atrophy) of the affected muscles can occur.
Other common causes of pain after back surgery
A comprehensive physical examination should be preformed if a patient suffers from continued back pain or leg pain after a laminectomy or discectomy surgery procedure. An appropriate diagnostic imaging technique should often be able to locate the cause of the pain. 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.
Every year in the United States there are approximately 200,000 lumbar laminectomy and discectomy (microdiscectomy) surgeries performed. In these 200,000 surgeries, ninety percent of them will have a positive outcome. The search for solutions to the other 10% of surgical patients with continued pain begins with an assessment of the cause for the back pain or leg pain.
The clinical profile of epidural fibrosis
Most often the symptoms that are associated with epidural fibrosis will appear about six to twelve weeks after the back surgery process. Usually this is preceded by an initial period of pain relief after the surgery. As time draws on the patient slowly develops recurrent back pain or leg pain. The improvement will sometimes occur immediately after the back surgery, although sometimes the nerve damage from the original pathology has the nerve heal more slowly.
If the patients leg pain continues after the surgery but begins to improve over the next three months, he or she will most likely continue to improve. If there is no improvement made within three months of the initial surgery, it is not likely to have been a successful procedure. The patient will continue to have back pain and leg pain.