Updated: Feb 23
Scar tissue formation is part of the normal healing process after spine surgery. For most people, this is painless, because the scar tissue itself has no nerve endings. But, when scar tissue forms near the root of a spinal nerve, the tissue may adhere to the nerve root, resulting in a painful condition called epidural fibrosis.
Epidural fibrosis pain seems to come out of nowhere, months after the surgery, just as the patient begins to believe they are turning the corner toward a life without constant, debilitating back pain. They are two to three months into recovery, past the fear of infection, through the discomfort of physical therapy, getting back into their old routines, when, suddenly, the old pain is back… often even worse than it was before. Feelings of hope and joyful expectation are crushed by self-defeat and hopelessness. Many patients come to us in this situation and say: “I was starting to feel so good, why am I suddenly hurting so much?”
Why Epidural Fibrosis Causes Sudden, Recurring Back Pain
When a surgeon performs a procedure near the spine, scar tissue will form. Sometimes, this scar tissue on the spine compresses or sticks to the nerve root. These fibrous adhesions can be very painful, causing sharp, recurrent pain in the back that radiates down into the legs. And the worst part is, this sudden onset of pain often comes after a relatively pain-free period, when the patient begins to feel like they’re finally on the mend. It can take up two to three months for scar tissue to form. By this time, many post-surgery patients are up and around, beginning to take their first steps into a new life, when the pain they thought they were free of comes roaring back. Fortunately, for patients who find themselves in this difficult, discouraging situation, there are several non-surgical or minimally-invasive treatment options that can offer them real hope.
Diagnosing scar tissue on the spine
The timing of the pain is one of the first indicators that back pain after surgery may be caused by epidural fibrosis, but further tests are generally necessary to make an accurate diagnosis. An MRI can help to determine if there is any scar tissue causing pain. If the MRI results are inconclusive, the doctor may suggest further tests.
One of the best diagnostic tests for determining if scars near spinal nerves are causing back pain is called an epiduroscopy. In this procedure, the doctor inserts a small scope into the painful area to get a close-up look at the nerve root. This test offers multiple benefits. Not only will the doctor be able to tell if scar tissue has adhered to the nerve root, but they can also determine if there may be other causes of the pain, such as inflammation, disc degeneration, herniation, or failed back surgery.
Treating pain due to a spine surgery scar
If diagnostic testing determines that epidural fibrosis is the most likely cause of post-surgical spine pain, traditional surgery is generally not a viable treatment option. According to some reports, only one-in-three people suffering from epidural fibrosis experience relief after a follow-up surgery. Worse, one-in-five reported increased pain after the second surgery. Fortunately, there are other, minimally-invasive options which have helped people find relief from pain after back surgery.
Medication: pain reducers such as acetaminophen or non-steroidal anti-inflammatories such as ibuprofen may help take the edge off the pain, making physical therapy and therapeutic stretching more tolerable.
Physical therapy: targeted exercises under the direction of a medical professional will strengthen your core muscles and increase flexibility along the spine.
Friction massage: some sports massage therapists specialize in a technique called cross-fiber friction which helps prevent painful epidural scars and encourages proper healing.
Epidural steroid injection: a pain-relieving combination corticosteroid and anesthetic numbing agent is injected into the epidural space of the spine. While ESI can be effective in the short-term, it is generally not considered a long-term solution for back pain. ESI does offer better short-term pain relief than over-the-counter medication, making stretching and strengthening exercises easier, which encourages long-term pain relief.
Percutaneous adhesiolysis: this treatment disrupts epidural adhesions on the nerve root. Generally recommended only after epidural steroid injections fail to reduce or eliminate back pain due to epidural fibrosis.
Spinal endoscopy: in this minimally-invasive procedure, the physician uses an endoscope, a high-definition camera, to diagnose or treat back pain. This treatment option offers less chance of collateral damage to surrounding tissue, less blood loss, less pain, less risk of complications, and better clinical outcomes than traditional spine surgery.
If you are suffering with back pain after spine surgery, we can help. Our goal is to relieve your pain and get you “Back to Life” without another invasive, risky spine surgery. To learn which remedy for back pain may be best for you, click here to schedule an appointment.