Postoperative fibrosis

The most frequent abnormalities are: Lumbosacral transitional anomalies Scoliosis Hyperyphosis Hyperlordosis Rectification Spondylolysis Spondylolisthesis Vertebral arthritis Facet arthritis Spinal stenosis Fissure, protrusion and disc herniation Postoperative fibrosis Dislocation of the coccyx Atlantoaxial Dislocation Sprain Whiplash Syndrome

What it is

All incisions produce scarring, which consists of a repair process by which the cut tissue is replaced by fibrous tissue. Postoperative fibrosis, strictly speaking, corresponds to secondary surgical scarring, but the term may be referred to those cases where excessive scarring is present, that is, the formation of more fibrous tissue than needed. If after a spinal operation this excessive scarring compresses a nerve, it elicits intense pain.

How it takes place

It is accepted that the major risk factors to develop postoperative fibrosis depend on:

• The scar: The greater the surgical wound extension and bleeding, the greater the risk for developing fibrosis.
• The patient: Some individuals have a spontaneous tendency to scar more than needed; even little skin cuts give rise to excessive scarring ("keloids").

It is very important to prevent risk of postoperative fibrosis, since it is a painful situation with a complex and not always feasible treatment. The best way to prevent the risk of postoperative fibrosis is:

• To only operate on those patients who will derive clear benefits: Strict selection of patients.
• To use the least aggressive surgical techniques, such as microsurgery, which generates less bleeding and smaller scars.

Symptoms

The pain typically caused by post-surgery fibrosis is one in which the pain that radiates to the leg - in the case of lumbar surgery - or to the arm - in the case of cervical surgery - is more intense than the back pain, and in which the pain, although it can worsen with certain postures, can be almost constant.

Not all of the pain that appears after spinal surgery is due to post-surgery fibrosis. For example, after surgery for a herniated disc, even if it is done perfectly, there can be pain due to the facet joint being affected, or due to muscle contracture. This pain would be due to causes other than the surgey or scar tissue.

Risk

Post-surgical fibrosis can sometimes produce compression of a motor nerve fiber, causing loss of strength.

Diagnosis

Magnetic Resonance Imaging can detect post-surgical fibrosis. The clinical history and physical examination are essential to determine whether the fibrosis detected by Magnetic Resonance Imaging is the cause of the pain.

Neurophysiological tests can detect compression of the nerve fibers

Treatment

In the past, when diagnosing that the cause of pain was nerve compression due to postoperative fibrosis, the patient was re-operated to "free" the compressed nerve. After a couple of months the second operation scarring had produced even greater nerve compression and the problem became worse depending on how many times the patient was operated on. Nowadays, postoperative fibrosis is treated by other methods, such as the implantation of stimulation electrodes or morphine pumps.