From the Guidelines
Scar tissue formation is a common occurrence in disc herniations, happening in most cases to some degree, as part of the body's natural healing response to the injury. When a disc herniates, the inner gel-like nucleus pulposus pushes through a tear in the outer annulus fibrosus, causing inflammation. The body responds by sending inflammatory cells and fibroblasts to the area, which produce collagen to repair the damage. This collagen forms scar tissue, which is less elastic and functionally inferior to the original disc tissue.
- The extent of scarring depends on several factors including the severity of the herniation, individual healing factors, and whether surgical intervention was needed.
- While this scarring is part of the healing process, it can sometimes cause problems if it forms adhesions that compress nearby nerves, potentially leading to continued pain or restricted movement.
- According to the most recent evidence, such as the study published in the Journal of the American College of Radiology in 2021 1, routine imaging for acute low back pain without red flags does not provide clinical benefit and may lead to increased healthcare utilization.
- Physical therapy during recovery can help maintain mobility and potentially minimize excessive scarring.
- Anti-inflammatory medications may help control the inflammatory phase of healing, potentially influencing scar formation, though they won't prevent it entirely, as noted in various studies including those referenced by the American College of Physicians and the American Pain Society 1.
From the Research
Scar Tissue Formation in Disc Herniations
- Scar tissue formation is a common issue in disc herniations, particularly after surgical interventions 2.
- Lumbar epidural fibrosis is believed to be one of the mechanisms involved in the genesis of recurrent radicular pain after lumbar micro-discectomy 2.
- The use of absorbable gel to separate disc remnants, muscle, or bone structures from the nerve roots may reduce the amount of scar tissue surrounding the nerve and improve outcomes 2.
Prevalence of Scar Tissue Formation
- Recurrent radicular pain after lumbar micro-discectomy may lead to reduced quality of life for patients, and scar tissue formation is a potential contributor to this condition 2.
- The exact prevalence of scar tissue formation in disc herniations is not specified in the available studies, but it is recognized as a significant issue in the management of lumbar disc herniation 3, 4.
Management and Prevention of Scar Tissue Formation
- Conservative management, including physiotherapy and pain-reducing treatments, is often the first line of treatment for lumbar disc herniation 3, 5.
- Surgical interventions may be necessary in some cases, but the risk of scar tissue formation and recurrent radicular pain should be considered 4, 2.
- Regenerative biological therapies, including gene therapies and tissue-engineered constructs, are being explored as potential treatments to address the degenerative process and prevent scar tissue formation 6.