Post surgical scarring incidence

[bedrock]

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I’ve searched but can’t find a paper to directly answer this.

What percentage of non fusion spine surgeries result in post surgical scarring and chronic radiculopathy?

Not necessarily bad enough to require SCS, but the relative incidence of this after smaller spine surgeries such as discectomies and laminectomies ?

 

[callmeanesthesia]

I don’t have data for you, only anecdote, but I’d say not frequent. Patient and surgeon dependent factors though. With disc herniations, the chronic radics I’ve seen were often due to somebody who probably should have had immediate discectomy and didn’t. The laminectomies for degenerative-related stenosis don’t decompress the foramen so not surprising if they continue to have a radic as well, not really the surgery’s fault.

 

[bedrock]

I don’t have data for you, only anecdote, but I’d say not frequent. Patient and surgeon dependent factors though. With disc herniations, the chronic radics I’ve seen were often due to somebody who probably should have had immediate discectomy and didn’t. The laminectomies for degenerative-related stenosis don’t decompress the foramen so not surprising if they continue to have a radic as well, not really the surgery’s fault.

I think the spine surgeon community has specifically avoided publishing this information.

And I’m not referring to patients who waited too long for disectomy or have an inadequate lami.

I mean patients with post epidural fibrosis and radiculopathy after non fusion surgery.

Our samples are skewed of course as pain physicians seeing surgical failures but I would expect it to be at least 1% of all discectomy or laminectomy surgeries.

What does everyone else think ?

 

[MD87]

Anecdotally, my patients with persistent symptoms in the setting of scar tissue tend to be patients who had discectomy for lateral/foraminal herniations. Cannot even guess what the % is.

 

[SSdoc33]

has to be the same % as in general surgery patients. it is a phsyiological response. sometimes it cna become clinically sugnificant, but usually doesnt -- so there'd be no need to get an updated MRI

i imagine you could extrapolate any data you find in the general surgery field to spine surgery as well

 

[bedrock]

has to be the same % as in general surgery patients. it is a phsyiological response. sometimes it cna become clinically sugnificant, but usually doesnt -- so there'd be no need to get an updated MRI

i imagine you could extrapolate any data you find in the general surgery field to spine surgery as well

Good point. However, I think a higher percentage of other types of surgery don’t lead to the same morbidity because they aren’t performed next to the abundance of large nerves in the spinal canal.

 

[SSdoc33]

Good point. However, I think a higher percentage of other types of surgery don’t lead to the same morbidity because they aren’t performed next to the abundance of large nerves in the spinal canal.

Other morbidities. Adhesions, bowel obstructions, keloids, seizures.

I guess I’m not a huge believer in arachnoiditis or post surgical spinal pain from scarring. It exists, it’s not like chronic Lyme or EDS pain where it’s really wacky…. But when we see that scarring on an MRI, it is incidental in many cases