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  • rblock
    Member
    Post count: 8

    Hi Dr. Corenman,

    My question relates to scar tissue invasion of the laminotomy site, causing sciatic pain. I believe I may have this condition, along with a small reherniation at L5-S1. It’s unclear yet, which is causing me pain.

    If it is scar tissue, would you recommend surgical removal and are there any options for covering the nerve root to protect it from scar tissue invasion post surgery? I am a very active and healthy 33 year old male.. if that helps.

    Thank you for any information!

    Donald Corenman, MD, DC
    Moderator
    Post count: 8460

    Scar tissue is unusual to cause nerve pain but it can happen. If there has been a previous surgery and the nerve root is mildly adhered, a small herniation can cause significant pain as the nerve cannot “get out of the way” of the small disc herniation.

    There is a new product made out of amniotic membrane that might reduce the scar tissue as it lays down a “nonreactive” barrier. The jury is still out on that.

    Scar tissue surgery by itself is about 50/50 for some relief of pain but if there is also a disc herniation, the odds improve significantly.

    Dr. Corenman

    rblock
    Member
    Post count: 8

    Dr. Corenman,

    Thanks for the reply. I will be coming to your clinic on June 14th for an eval. I look forward to seeing you and Eric again.

    Are you using this amniotic shield product or do you know any clinics who will use it? Also, I noticed prolotherapy can be used to help scar tissue.. is this a possibility as well?

    Ryan

    Donald Corenman, MD, DC
    Moderator
    Post count: 8460

    I do use the amniotic barrier on some recurrent herniations but not all. It depends upon the amount of scar tissue that forms.

    Prolotherapy does not work to treat scar tissue. Actually, it is the converse. Prolotherapy is designed to form and promote scar tissue.

    Dr. Corenman

    rblock
    Member
    Post count: 8

    Thank you for taking the time.

    This is my fourth bout with acute sciatic pain (back, hip, thigh, calf, ankle) in a year and a half. I was hoping to avoid surgery, but here we are..

    If there is scar tissue relating to the laminotomy, could further disruption at the site make the scar tissue worse, perhaps debilitatingly worse? How big is the risk?

    Should I consider an endoscopic surgery that accesses the spine to the side of the spine, through the muscle (therefore going in at different angle / different route) – my current scar is directly medial over the spine.

    Last question, I promise, I mentioned earlier that I will be coming to Vail for an eval and an MRI June 14th. But, a month and a half away, I’m feeling like I should get the MRI now. Are all MRI machines created equal or is Vail vastly superior to, for example, the one we have here in Jackson Hole? Just wanting to get the best pictures available, as soon as possible..

    Thanks in advance,

    Ryan Block

    Donald Corenman, MD, DC
    Moderator
    Post count: 8460

    I am unclear if you have had one or two prior surgeries.

    Scar tissue is ubiquitous after any surgery and is not normally a problem for further surgical nerve root decompression. Endoscopic decompressive surgery in my opinion is actually more dangerous as the surgical field of view is limited and there is less room to free up the nerve.

    Scar tissue can occasionally increase with further surgery. This is why the typical rule for decompressions in one area is three. If there has been three separate herniations at the same disc location, the third decompression should have an accompanying fusion to ablate the disc and prevent any further herniations from occurring.

    Dr. Corenman

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