Granulation tissue is made up of white blood cells, platelets, myofibroblasts and other cells that are designed to remove debris and form scar. Most of the time, the scar tissue formation is minimal with no significant consequences. Some individuals for reasons yet to be understood, form significant amounts of this granulation tissue.
This tissue can be inflammatory which is quite irritative to the nerve root or compressive (causing similar effects as a disc herniation). Most of the time, over time this tissue will shrink down and the nerve will calm down. For these patients, I do use an epidural injection as steroid reduces swelling and reduces the ability of this granulation tissue (remember white blood cells) to cause irritation.
Now-a recurrent disc hernation can occur and then be surrounded by granulation tissue. This will show a “dark spot” in the middle of the highlighted area (on a T1 post-gad image). Look at the axial T1 images that are before and after gadolinium as gadolinium is white on these images and outlines the granulation tissue (it lights up).
Dr. Corenman
Donald Corenman, MD, DC is a highly-regarded spine surgeon, considered an expert in the area of neck and back pain. Trained as both a Medical Doctor and Doctor of Chiropractic, Dr. Corenman earned academic appointments as Clinical Assistant Professor and Assistant Professor of Orthopaedic Surgery at the University of Colorado Health Sciences Center, and his research on spine surgery and rehabilitation has resulted in the publication of multiple peer-reviewed articles and two books.