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Lumbar Adhesions

What are Lumbar Adhesions?

Lumbar adhesions are scar tissue which has formed in the spine, usually from prior surgery.

Why do Lumbar Adhesions form?

Spine surgeries which open the spine to correct a problem have to “dissect” the spine. “Dissection” means that structures such as muscle, ligaments, tendons, and often pieces of the vertebrae have to be either separated or partially removed. The spine reacts to the dissection by forming scar tissue. Often a significant amount of scar tissue follows a spine surgery.

Scarring is thought to happen from trauma to the tissue which causes bleeding and inflammation. During the course of the inflammation, scar tissue forms.

Where in the spine do Lumbar Adhesions happen?

Depending on the type of spine surgery, there are a number of places in the spine where adhesions can occur:

  1. Epidural Space

This is a space located outside the spinal cord and the lining of the spinal sac (dura). Most spine surgeries have to enter this space to remove disc material, bone spurs, etc. This space tends to scar easily.

      2. Spinal Nerves

Surgery for disc herniations and sciatica involves working directly around the spinal nerves. These nerves are also prone to inflammation and subsequent scarring.

      3. Dura

Surgeries on the disc, spinal nerves, and spinal canal are in direct contact with the dura. The dura can scar to the other tissues in the spine.

      4. Spinal Muscles

In the process of opening the spine to fix a problem, the spinal muscles are separated from their attachments to bone. After that, the muscles are pushed out of the way to see the deeper structures in the spine such as the disc.

Scarring of the spine muscles happens both from the trauma or separating them from bone as well as pushing them out of the way for longer periods of time during surgery.

What kind of symptoms to patients with Lumbar Adhesions have?

The symptoms from scar tissue in the spine depend on where the scarring happens. Here are some potential symptoms:

  1. Chronic muscle tightness, spasm and pain
  2. Nerve pain in the legs from scarring of the spinal nerves
  3. Chronic back pain from scarring around the disc in the epidural space.

How is the pain from Lumbar Adhesions treated?

There is no surgical treatment of the spine which can predictably remove scar tissue without risking more scarring.

Many different attempts have been made to remove scar tissue from the spine using special tools and medications. However, there is no guarantee that a surgery or procedure to remove scar tissue does not run the risk of causing more scarring.

Most of the treatment of pain from scar tissue is not about removing it, but managing the pain from scar tissue. Here are some possible options:

  1. Non-Surgical Care

A. Alternative Health Care

Alternative Health care options can often complement conventional medical care. Massage Therapy, Acupuncture, Meditation exercises and Herbal Remedies can all help with the pain from this condition.

B. Nutrition and Weight Loss

Proper nutrition and weight loss can have a positive impact on many spine conditions. Excess weight on the spine often contributes to the symptoms of pain and spasms (Spine and Obesity).

C. Chiropractic Care

Chiropractic care including manipulation and adjustments of the spine can help with the pain and spasms from this condition.

D. Spine Exercises

Spine exercises can help with the muscle pain and tightness from this condition. Exercise also increases the amount of oxygen delivered to the spine which can help with healing. Pilates, Yoga and T’ai Chi can help maintain the spine’s flexibility.

E. Physical Therapy (PT)

PT has many modalities to offer for this condition. They can range from Manual Therapy and Exercises to Traction and Ultrasound Treatments.

F. Self Help Tools

Self Help Tools are items which can be purchased to help with back pain. They range from Back Braces to Back Mattresses and Ergonomic Devices such as chairs and computer accessories.

G. Spine Medications

Here are some of the common groups of medications which are available for this condition:

1. Non-Steroidal Anti-Inflammatory Drugs (NSAIDS)

2. Muscle Relaxants

3. Pain Killers

4. Nerve Pain Medications

H. Spine Injections

Depending on the exact spine condition which is causing pain a specific spine injection can offer some help.

  1. Lumbar Interlaminar ESI
  2. Lumbar Transforaminal ESI
  3. Lumbar Nerve Rood Block
  4. Caudal ESI
  5. Lumbar Trigger Point Injection
  6. Lumbar Muscle Block

I. Implanted Devices for Pain Relief

Here are some devices which can be implanted in the body for pain relief:

  1. Thoracic Spinal Cord Stimulation
  2. Lumbar Spinal Cord Stimulation
  3. Intrathecal Pain Pump Implantation

 

      2. Surgical Care

Surgical treatment is reserved for patients with severe conditions such as poor quality of life due to pain or nerve dysfunction. Surgical treatments depend entirely on the type of problems and can be diverse.

Here are some potential surgical options:

  1. Lumbar Fusion
  2. Lumbar Dynamic Stabilization