Subject: Re: Sciatica
Forum: The Neurology and Neurosurgery Forum
Topic Area:
Posted by CCF Neuro MD on July 10, 1997 at 16:24:51:
In Reply to: Sciatica posted by D. Luckey on July 02, 1997 at 12:06:00:

: I had back surgery (diskectomy) on the L5 and S1 area four years ago. The surgery was successful and no folowing complications. This March I injured my back again causing the sciatic pain to return. I have been treatted with nsais's and hydrocodine. This has helped the pain enough to where I can get out some days and walk a fair distance. Some days are horrible with little mobility but around the house.

I have recently been undergoing Electro-Acuscope therapy & Myeopulse with no improvement. I have also gone through tradition massage therapy, ultrasound therapy and traction(painful), with no improvement. I appear to be stuck.

MRI shows scar tissue at L5 site. Dr. says this is probably the cluprit. He wants me to go to a pain management Dr. This seems so final. Can't surgery be done to remove the scar tissue. I know it will be replaced by more scar tissue, but might it be successful as with the first surgery?

Dear D. Luckey:

What you describe has been called the "failed back syndrome". As many as a quarter of patients undergoing back surgery may either have no relief of pain, or a recurrence of similar or different pain after a variable period. There are a variety of causes of this syndrome, such as persistent nerve root compression from disc, facet joint disease, foraminal stenosis, and others. The majority of cases, however, do not reveal any clear cause of the pain on the MRI; these patients, on operative exploration, may show some degree of thickening or adhesion of meninges (covering of the roots and spinal cord in the spinal column). Such patients are often labelled as "arachnoiditis" (the arachnoid membrane is a component of the meninges).
Although lysis of adhesions or scar tissue has been attempted, at times with modest success, surgery is usually not the treatment for the failed back syndrome. Some patients benefit from epidural injection of steroid or local anesthetic. Similar injections may be tried into the facet joints, if facet joint disease is the suspected culprit. These treatments do benefit individual patients, but may not be effective in the long term.
In case you live in the Cleveland area, I recommend that you see a doctor in the Spine Center of the Cleveland Clinic. The telephone number to call for appointments is (216)444-2225. The Cleveland Clinic also has a very active Pain center.
This information is provided for general medical educational purposes only. Please consult your physician for diagnostic and treatment options of your specific medical condition.

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