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SCAR TISSUE COMPRESSION
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SCAR TISSUE COMPRESSION


  I'm a 43 year old male  in great shape except. Two years ago I was diagnosed with a disc herniation left side L5-S1.I attempted conservitive treatment corizone injection,physical therapy, mild streching. The pain continued, mostly left S-1 nerve root pain.loss of some feeling on the outside of my foot and 3 smaller toes,reduced reflects at the knee and ankle. My Orthopedic surgeon advised a Microdiscectomy at L5-S1. Two weeks after surgery Jan. 98 same pain, fail back surgery syndrome. I have been surviving on endoscopic epidural injections which last 4 to 6 weeks with advil and perocet in between. I am in South Florida now and had a discogram ,flection extenion x-ray both negative. Recent MRI report, Impression:  degenerative disc disease at L5-S1 statrus post microdiscectomy  and left L5-S1 hemilaminectomy. Enhancing scar around the decending left S1 nerve root. No definite disc herniation or significant disc bulge present.
  Two neurosurgeons advise that my pain is caused by scar tissue compressing the nerve root and the odds are not good at correcting this surgically.
  Two other Neurosurgeons advise that due to my degenerative state complicated
  by the disc herniation, the lack of space between the two vertebrea are causing the compression on the nerve root.I do not have bilateral pain  I have mostly left leg, buttock,  and some back pain when provoked. Conclusion, Cage fusion with a laminectomy, removal of scar tissue and repack S1 nerve root with some kind of gel to prevent future growth of more scar tissue.
  What are your thoughts on cage fusions for decompressing nerve roots?
  Can scar tissue surrounding a nerve root be removed and how ?
  Is their a gel that can prevent the scar tissue from reforming?
  What are your thoughts on my condition?    Thanks
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Dear Steve,
These are good questions that spinal surgeons are trying to answer objectively with clinical studies.  The repeat surgery would accomplish a few goals.  First is to decompress the S1 nerve root from the scarring from previous surgery.  There is a new material on the market that claims to inhibit scar formation, though we have not physically seen feedback in our patients.  The prospect of inhibiting scar formation is appealing, though.  The second goal would be to fuse the vertebrae at L5/S1.  After a disc is removed a patient is at higher risk to have a 'slip' of one vertebrae on another.  The technical name is spondylolisthesis.  This can cause pain and eventually neurological deficits in some cases.
The whole issue of fusions and who should be fused has yet to be answered completely and objectively, though we have some early data.  The procedure itself is quite successful in the vast majority of cases.  Speak to your surgeon as to whether the fusion is necessary.  He should be able to rationalize the fusion along the lines as discussed above.
Good luck.






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