Scar Tissue and Chronic Pain After Spinal Fusion Surgery

If you’ve decided to undergo spinal fusion for back pain, you’re looking forward to pain relief and improved mobility. Unfortunately, this isn’t a reality for patients who develop chronic pain from scar tissue. 

Scar tissue is your body’s normal response to tissue damage. It helps your body close wounds and recover. But, when it develops in excess or too close to a nerve, it can trigger ongoing pain and compromise the benefits you expect to gain from spinal surgery.

Read on to learn more about scar tissue and chronic pain after spinal fusion surgery

What is Scar Tissue?

Scar tissue is a type of tissue consisting of collagen fibers and other cells that the body produces in response to tissue damage. Cuts, burns, infections, surgeries, and tissue inflammation can all stimulate scar tissue development.

While scar tissue is a natural, healthy bodily process that can help you heal, it can have long-term complications. It doesn’t function as normal, healthy tissue; it’s tough and fibrous. Scar tissue’s lack of elasticity can compromise your mobility, trigger stiffness, and even reduce blood flow to the area.  

Can Scar Tissue After Back Surgery Cause Pain?

Scar tissue after back surgery can cause pain if it presses on nearby nerve roots or compromises your mobility.

Clinical research shows that excessive scar tissue after spinal surgery can protrude into the spinal canal and press on nerve roots. When scar tissue develops excessively near a nerve root, it’s known as epidural fibrosis. 

Symptoms of epidural fibrosis include: 

  • Moderate to severe back pain that slowly worsens after spinal surgery
  • Pain that radiates into the lower extremities
  • Burning pain that doesn’t improve by changing positions
  • Recurrent back and leg pain

Patients who undergo more complex back surgeries are at a higher risk of developing epidural fibrosis

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What Causes Overproduction of Scar Tissue?

Certain factors can increase your risk of scar tissue overproduction after back surgery, including:

  • Age: Younger patients often develop more scar tissue than older patients because their bodies have a more robust response to tissue damage. 
  • Poor wound care: After surgery, it’s important to properly care for the wound by keeping it clean and moist. Change the dressing as needed, and keep the wound away from direct sunlight. 
  • Chronic inflammation: The more inflamed the damaged tissue is, the more scar tissue is likely to develop. 
  • Genetics: Certain genetic factors can lead to scar tissue overproduction, like having family members with keloids.  
  • Underlying medical conditions: Hypertension, diabetes, and autoimmune conditions can cause excessive scar tissue production. 
  • Smoking: Nicotine constricts blood vessels, reducing blood flow throughout the body. This can delay wound healing and compromise cell function, causing worsened scar tissue production. 

Can Scar Tissue Cause Nerve Pain?

Yes, scar tissue can cause nerve pain when it develops on or near a nerve. 

When scar tissue neighbors or surrounds a nerve, it can press on it, causing inflammation, pain, tingling, weakness, and numbness. Scar tissue can also diminish blood flow to the nerve tissue, inhibiting the healing process. 

In some cases, when scar tissue develops near a nerve, it leads to a tethered spinal cord. With this condition, the spinal cord attaches to the tissue around the spine, which constricts its movement. This may cause the spinal cord to stretch beyond its normal range, causing damage and pain. 

What Does Pain from Scar Tissue Feel Like?

Pain from scar tissue can feel different from person to person, but common descriptors include:

  • Achiness
  • Burning or stabbing pain
  • Sharp pain
  • Tingling
  • Throbbing 
  • Tightness 
  • Itchiness
  • Stiffness and poor mobility

Scar tissue pain can range from mild to severe. In some people, it goes away gradually with postoperative physical therapy. In others, it becomes a chronic, debilitating issue. To prevent chronic pain from scar tissue after spinal fusion, it’s important to attend all of your recommended PT appointments and remain mobile, without extended periods of bed rest. 

How to Break up Internal Scar Tissue?

To break up internal scar tissue, you can try manual therapies including deep tissue massage, cross-friction massage, manual stretch therapy, cupping, dry needling, and myofascial release, as well as targeted exercises for joint mobility. 

These manual therapies are available from physical therapists and can help break up scar tissue after back surgery:

  • Deep tissue massage is a massage technique that hones in on the deeper muscle and connective tissue with firm pressure. The intensive pressure used in deep tissue massage can help break up the collagen fibers and adhesions that contribute to pain from scar tissue. 
  • Cross-friction massage is also referred to as transverse friction or deep friction massage. To perform it, your PT will apply pressure to the targeted area in motions that are perpendicular to the muscle fibers. This approach helps disband scar tissue fibers, making the area more flexible and mobile. 
  • Manual stretch therapy involves various targeted manual techniques intended to improve mobility and reduce muscle tension.
  • Cupping is an ancient therapeutic technique that involves placing specialized cups on the skin, creating suction that pulls the tissue upward. The cup is left on the skin for a few minutes. This technique is thought to help break up scar tissue by separating the fascial layers and improving scar mobility. It also boosts blood flow to the area, which promotes healing and prevents more scar tissue from forming. 
  • Dry needling is a technique that involves inserting thin needles into trigger points in the tissue, stimulating an involuntary spasm. Superficial dry needling involves inserting the needle into the subcutaneous tissue instead of the muscle, which is thought to help with scar tissue by reducing tension and improving blood flow. 
  • Myofascial release is a type of massage that targets pain and tension in the myofascial tissue, a thin connective tissue surrounding the body’s muscles, bones, nerves, organs, and blood vessels. Myofascial release can help break up scar tissue and adhesions, reducing pain and enhancing mobility. 

How is Pain from Scar Tissue Treated?

Pain from scar tissue may be treated with manual therapy, compression techniques, and, in severe cases, revision surgery. 

After spinal fusion and other types of back surgery, your physician may suggest compression to address scar tissue. Compressing the affected area helps reduce inflammation and pain. In combination with the manual therapies discussed above, this technique may help you avoid revision surgery for scar tissue. 

The more invasive the procedure, the more likely you are to develop significant scar tissue. Spinal fusion alternatives like the TOPS System help prevent complications while preserving your spinal mobility. Talk to a doctor in your area today to learn more!