WHEN TO SEE A SPINE SPECIALIST

You should seek the advice of a spine specialist if neck or back pain persists for more than two weeks or if it is progressive in intensity and/or distribution. You should seek immediate healthcare attention if neck or back pain occurs as the result of an injury or if it is associated with serious illness and/or a high fever. Additional signs and symptoms which warrant prompt medical attention include:

• Neck or back pain associated with bowel and/or bladder dysfunction
• Neck or back pain associated with extremity weakness or difficulty with coordination
• Extremity numbness or muscle weakness
• Neck or back pain that is associated with impaired walking (gait) or difficulty with balance
• Numbness, tingling and/or muscle weakness associated with a back or neck injury

SCREENING AND DIAGNOSIS

Spinal X-rays do not show scar tissue (fibrosis). X-rays may reveal the site of spine injury or surgery where scar tissue is more likely to be present. Computerized tomography (CT) scan may demonstrate abnormal soft tissue density compatible with scar but MRI is the test of choice for evaluating spinal scar tissue (epidural fibrosis) . The use of chemical contrast agents with MRI help to brighten up scar tissue. This extra step helps to differentiate epidural fibrosis from other types of spinal tissues including recurrent or residual disc material. MRI can be used to evaluate the relationship between scar tissue and surrounding tissues such as the spinal nerves and pain sensitive membranes in the spinal canal. In special circumstances a small camera may be placed into the spinal canal in an attempt to locate and reduce epidural scarring. This diagnostic approach is referred to as epiduroscopy.

There are a number of conditions which can cause the same or similar signs and symptoms as fibrosis. An appropriate workup is needed to rule these conditions out. Some of the more common considerations are:

• Recurrent Disc Herniation
• Post-operative Bleeding
• Arachnoiditis
• Epidural Abcess/phlegmon
• Pseudomemingocele

CAUSE

Scarring is a part of the normal healing process of the spine after injury or surgery. Excessive or thick scar formation can lead to persistent and/or progressive signs and symptoms. Minor or mild scar tissue formation can occur or exist without any signs or symptoms.  The extent of scar tissue often is often related to the severity of tissue compromise and the mount of bleeding. The individual’s natural inflammatory response to tissue injury can predispose one to greater scar formation.

Epidural scar tissue will normally develop as the result of a surgical procedure. The scar remodels, changing in degree, distribution and in quality with passing time. Most of the changes occur within first 3 months after surgery. Much of the fibrosis is dissoluted and or reabsorbed thus never causing a problem.