Treatment of Scar Tissue

The best approach is to try to limit scar tissue formation to begin with.  The conservative treatment of excessive scar tissue formation requires avoidance of recurrent trauma, a reduction of inflammation and maintaining mobility of tissue during the remodeling phase of healing.  If conservative and rehabilitation approaches do not work, more aggressive options to reduce scar include the use of specialized procedures including the Racz procedure, epiduroscopy (adhesiolysis), and laser epiduroscopy.  Procedures used to help treat pain associated with scar include neuromodulation techniques such as spinal cord stimulation, dorsal root ganglion stimulation or the placement of intrathecal infusion pump. 

Re-operation to free scar tissue may result in additional scar tissue formation unless special precautions are taken.  The use of Adcon or Adcon-L or another barrier gel may help prevent the reoccurrence or proliferation of scar.  Strategic placement of fat around a spinal nerve during surgery may help prevent significant adhesions from attaching to the nerve.  The formation of epidural scar tissue (fibrosis) within the spine after spinal surgery can contribute to failed-back syndrome (FBS), which is generally characterized by persistent extremity pain, numbness and occasionally weakness.

Arachnoiditis and Epidural Fibrosis

The term arachnoiditis refers to chronic inflammation of the arachnoid layer of the specialized membranes (meninges) that surround the spinal cord and spinal nerves.  The term epidural fibrosis or epidural scar refers to scarring outside these special membranes or outside the dural sac.  The latter is often referred to as adhesions or scar tissue.  The presence of epidural fibrosis differs from arachnoiditis in that the former is more likely to be a localized problem.  This is most often the result of surgical intervention.  It can also occur secondary to minimally invasive procedures.  With arachnoiditis, there is often associated epidural scar, but there is greater involvement of the arachnoid layer of the meninges.

The presence of adhesive scar can lead to tugging of dural membranes and subsequently contribute to the development of non-infectious arachnoiditis.  Chronic inflammation of the arachnoid membrane can result in arachnoid adhesions, which refer to tiny areas of scar, which can adhere to adjacent membranes.  The presence of an inflamed arachnoid membrane with adhesions is referred to as adhesive arachnoiditis (AA).  This may be mild or moderate-to-severe in degree, and can be either localized or diffuse in presentation.  Adhesive arachnoiditis may be under diagnosed.  It is felt by many specialists to be a contributing factor to the development of failed back syndrome (FBS).

Complications of Scar Tissue

Perfect restoration of spinal tissue function after severe injury or surgery is unlikely. Some degree of scar formation almost always occurs. Depending on tissue and amount of scar tissue produced, any of the following may occur:

• Interference with soft tissue movement
• Limited spinal segment movement
• Scar tissue can cause strictures
• Adhesions to adjacent structures may occur
• Reduced circulation