Do NOT underestimate the Scar Tissue... Issue

[bman]

I have read some posts relating to post surgical treatments, abnormal pain sensations and hyperesthesia, and when I see the bios of my fellow peeps and see buko surgical options that you all have incurred (more like endured actually) Give that EVIL Scar tissue demon some credit!

Scar tissue is insidious in its progressive creeping. The Good Lord made scarring as a mechanism to allow for healing of a previously opened area - in your cases surgically opened. Scar tissue remodels at about 70% of your original tissue tensile strength (if your lucky)

But here comes "the rub" that places people undergoing lumbar surgery, and it relates to what stops scar tissue from spreading, and that is applied internal tension (that would be stretching for you all from Rio Linden).

First off, this is the analogy I give to my pts concerning what scar tissue REALLY looks like - for better or worse btw
and that is that its visibly and texturally not unlike cotton candy, but at the same time sticky like a spider web.

Ever seen a surgical scar on a knee, elbow, wrist, etc? They heal flat on the outside, and if you could see internally (with a scope) that same scar layers flat in line with ligaments and muscle fibers in the same fashion. This occurs because at some point adequate stretching results in enzymes being produced from said scar that the brain intercepts -and in a way yet unknown to scientists- whereupon the scar STOPS GROWING, period. Remodeling complete.

HOWEVER, the mobility in the spine becomes less and less the farther you go distally from your head. So that scar tissue in between successive lumbar segments does not get that stretching to the point of enyzmatic breakdown, so its keep growing, and growing, and.... well you get the picture. And all the while its sticky, so what happens more than not is that lower motor nerves exiting the canal through foramen openings get trapped. Here just a little bit of adherence can cause BIG time pain.

Scar tissue is one of the primary reasons that these new less invasive surgeries have occurred. Cutting-edge techniques (no pun intended) are now being used to remove scar tissue in the spine, and I project in the near future an injectable solvent will begin to be used, tailored through gene therapies to dissolve excessive scarring.
What a breakthrough that will be...!!!!!

[trkdoc714]

Great description! The PT that treated me also addressed the scar tissue at the discectomy/ laminectomy incision sites. She explained it in a similar manner.

Thanks Bert!

Bob

[claudia]

Thank you for this post. I was told that the techniques currently available to remove scar tissue were not very effective, since the tissue usually grows back. Scar tissue is one of the things that scares me the most about having another surgery.

[Keano16]

There are few way of treating scar tissue:
1. Epiduroscopy
2. Ratz Chateter
3. Re-operation

There is a way to prevent creation of scar tissue after surgery, its called anti-adhesion gel.

And finally and most important, scar tissue does not occur in most minimallly-invasive procedures (like endoscopic discectomy) and this is one of the reasons why this techniques and equipment were invented, and this is why in following years there will almost be no traditional open surgeries for "simple" cases like herniated discs.

[Keano16]

Thank you for this post. I was told that the techniques currently available to remove scar tissue were not very effective, since the tissue usually grows back. Scar tissue is one of the things that scares me the most about having another surgery.

Yes, this is true. Gel seemed like a good idea, but now most of surgeons stopped using it - not sure why.

[bman]

I was under the impression that the gel was thought to impede early states of inflammation as well as scarring. Scarring is necessary and fits nicely into the normal remodeling curve, and the future will be [IMO] some type of focused injectable, targetted for post surgical, post early-initial remodeling healing phase(s) so as not to stop the scar tissue - but rather inhibit excess scar formation.

With regard to the prior post about therapist(s) explaining scar tissue mobilization and management, we (therapists) too often focus on the VISIBLE scar, which responds well to pressure as a way to limit the scar. Now that Mederma is around, hypertrophic scarring can effectively be at least partially remodeled Over The Counter.

A wise MD told me once - while observing a properly scarred incision site for multiple level laminectomy - to think of that scar as an iceberg.
"What your eyes observe might end up being only 10% of the total scar mass"

[KBear]

I had pain after surgery that was thought to be from adhesions. Through my research into the subject, they do have adhesion barriers they can put in during surgery. My understanding is that they are made of a material that is dissolveable, so the scar tissue hooks to it, then it dissolves (like internal stitches do), so they are just 'free floating' and not hooked to your organs and such. I called the manufacturer and searched for surgeons using them, but had no luck finding them in my area (North Texas). Most of the doctors I saw said, sorry there's nothing we can do. I finally found an OBGYN who was going to do a laprascopic procedure to remove an ovarian cyst and also remove any adhesions he found, but he was not interested in any of the barrier methods. I ultimately got better and did not have surgery.

I'm pretty nervous how the scar tissue is going to be as my belly grows throughout pregnancy, I can feel it below my external scar, so I know it's there. I'll also be having a c-section, which will cause more scar tissue. I can only hope that it doesn't cause me any issues.

[bman]

I find that very interesting that you would find an OBGYN that specializes in scar adhesion removal ( I assume via scope) KBear. Necessity truly is the mother of all invention!!!

It also is logically THE profession - from a surgical standpoint - that would probably know more about scarring than most others (I speak from an internal scar tissue perspective as general surgeons deal with burn care and that is a type of scarring)

That feeds directly into what I posted earlier also, that applied internal tension visa vi' stretching is needed to stop the growth of scar tissue. OBs depend on scarring to assist with bladder suspensions, and because those lower quadrants essentially have limited ability for internal stretching, OBs deal with the after effects of excessive scarring on a regular basis.
I would be interesting to see in their journals show a focus on scar issues.

B

[KBear]

He definitely didn't specialize in it, but was willing to do it and use the ovarian cyst as the reason for surgery (it was a small cyst, so not something that would usually be operated on). I saw so many doctors for my issues, but it was the OB's who seemed to know the most. I even had a colonoscopy out of the deal- LOL (gastro dr.)

[Cindylou]

Kathy, I don't blame you for being on high alert about scar tissue through out your pregnancy, and then, as you mentioned...having a C-section to boot. I'm also wondering if some folks make more scar tissue than others, you know? I remember my hip surgeon saying there was an extraordinary amount of adhesions went he went in a second time. He cleaned them all out, but one wonders....what's to prevent them from coming back. I can feel the scar tissue in my belly area. It almost feels like "a mass." It's that big. Ugh. Thank-you Bman for such an informative, albeit troubling, post. And welcome, btw, to SPS. Cindylou