Spine-Pain

Post lumbar spinal fusion surgery, my myelogram with CT scan indicates post operative scarring. Earlier this month, I received an invasive procedure called caudal lysis of adhesion. I received three days moderate chronic spinal pain relief, but no pain relief from my chronic legs nerve pain as wells as burning pain and numbness in my feet. Over the past two years, I have received three post lumbar spinal fusion surgery nerve root block injections. I received only 3 days moderate chronic spinal pain relief from each of these injections.

It is my understanding to be effective spinal injections should provide pain relief for six months or more.

I found the following online article.

Lumbar epidural lysis: a cranio-caudal lateral intralaminar approach

The standard approach for epidural lysis is reaching to the problematic area through the caudal canal. If the symptoms do not cease and no improvement is seen, a cranio-caudal approach can be tried. In a patient with back pain due to failed back surgery syndrome for six months, epidurography was performed using caudal approach under fluoroscopy in the first intervention. A catheter was progressed to fibrotic tissue for epidural lysis. But the pain regression was not satisfactory at the L4 dermatome. After 3 weeks, a second intervention was planned with the lateral cranio-caudal approach at the L3-4 level and a catheter was placed around the fibrotic tissue and lysis was applied. The patient’s back pain totally disappeared and neurological symptoms started to decrease at the end of the first week. We suggest that, for patients with low back pain due to failed back surgery syndrome, a cranio-caudal approach may be applied after caudal epidural lysis.

http://www.ingentaconnect.com/content/maney/tpc/
2005/00000017/00000002/art00017

A MRI with and without contrast might reveal scar tissue as the source of pain.

For a patient who has already had spine surgery, the contrast agent has traditionally helped in differentiating a recurrent or remaining disc herniation from scar tissue.

Scar tissue and pain after back surgery

Effects of scar tissue on back pain and leg pain

The formation of scar tissue near the nerve root (also called epidural fibrosis) is a common occurrence after back surgery—so common, in fact, that it often occurs for patients with successful surgical outcomes as well as for patients with continued or recurrent leg pain and back pain. For this reason, the importance of scar tissue (epidural fibrosis) as a potential cause of postoperative pain—commonly called failed back surgery syndrome—is controversial.

http://www.spine-health.com/Topics/surg/scar/scar01.html