What are spinal adhesions?

Adhesions or scars can occur anywhere - including the spine, at the neural structures, but also in the stomach and even at the heart. Adhesion, 'adhere', means 'to stick to something'. These are fibrous fibers that stick to the structures or organs. Adhesions manifest themselves after surgical procedures, injuries, bleeding, and inflammation. When they appear after an anatomical "successful" spinal surgery, we are talking about a post-nucleotomy syndrome. Even "healed" herniated discs leave adhesions that stick and put pressure on the neural structures.

Frequency - that is what international studies say about spinal adhesions

International studies have shown that adhesions after surgery are more common than we would think. Studies show that 67% of those who once had surgery also had adhesions. The rates were 81-93% in patients with large or multiple surgeries. In people who never had surgery, the number of adhesions reaches only 10.4%. The so-called post-nucleotomy syndrome develops in about 15% of all patients who have undergone disc surgery. In two-thirds of those affected, the causes of adhesions in the epidural space are visible through the MRI images.

Causes of spinal adhesions

HOW do spinal adhesions develop - if they are not a spinal surgery consequence? It is not easy to answer, because the adhesions are one of the best-kept secrets or puzzles of modern medicine. It is even possible that they occur due to genetic predispositions.

But of course, they are also caused by even non-surgical changes: inflammation, injury, chemotherapy, radiation or malignant diseases such as cancer. Adhesions also occur after spontaneous bleeding in the epidural space, after trauma and inflammation, and after a 'healed' spinal disc exit in the spinal canal. All of these processes represent "foreign bodies" in this area. Thus, adhesions could be understood as a protective reaction. Adhesions make the nerve roots almost immobile and worsen not only blood circulation but also cerebrospinal fluid circulation.

Symptoms of spinal adhesions

Symptoms concern medium-sized protracted pain in the leg, arm or back. Some weeks or months after surgery, radiation, injury, etc., burning or pulling pain is often felt with discomfort in the leg or arm.

Diagnosis spinal adhesions

Each diagnosis begins with the doctor-patient interview which means that in this case too, you need to tell your doctor where and how long you have been feeling pain. A magnetic resonance imaging with contrast agent shows clearly the adhesions. The contrast agent is a liquid that is injected in patients and should help - during MRI scans - to make the scar tissue clearly recognizable among other structures. This will help to differentiate new intervertebral disc incidences from adhesions.

Treatment of adhesions

One thing must be said very clearly: There is no simple solution to treat adhesions.

Is it possible to avoid adhesions intraoperatively? Intraoperative manipulations play also an important role: the less invasive the procedure is, the fewer adhesions are produced. When conventional procedures involve very large incisions, the risk of adhesions being created increases, for this reason, the careful preparation of the fibers during a surgical operation can prevent it.

Even after surgery, the tissue should have time to recover and regenerate. Early stress and strain on the tissue tend to develop adhesions.

However, if the pain is due solely to scarring around the adequately decompressed nerve root (new incident or instability) must be ruled out.

Three treatments can be considered: medication, the surgical and/or the psychological treatment. A careful and accurate surgical technique has been shown to be the most effective way to dissolve adhesions and prevent a relapse. The microsurgical variant is called adhesiolysis and includes also the infiltration of anti-scar gel. Another method is the epiduroscopy with which your doctor can visualize adhesions and inflammations in the spinal canal and dissolve them with fine instruments.

Medical pain therapy includes also a combination of painkillers. Pain therapy begins with simple painkillers, accompanied by physiotherapy and psychosocial therapy. Not infrequently, patients end up taking strong morphine supplements combined with anti-neuropathic and antidepressant substances.

A good alternative would be the spinal cord stimulation that generates electrical impulses in order to change or suppress the pain impulses.

Prognosis - this is how microsurgery helps with spinal adhesions

The microsurgery is a good alternative to the removal of adhesions. The anti-scar gel protects against scar development but what matters is to conduct adequate postoperative care. A combined therapy as outlined above is often successful.

Dr. med. Munther Sabarini

Author
Dr. med. Munther Sabarini
Specialist in Neurosurgery

Hans-Heinrich Reichelt

Co-author
Hans-Heinrich Reichelt
Chief Editor of Medizin für Menschen

The Avicenna Clinic in Berlin is always willing to help you

Since the year 2001, the Avicenna Clinic is based in Berlin. Our doctors have at least 25 years of international experience in their respective fields (neurosurgery, spinal surgery, anesthesia, and orthopedics).

If you have severe back pain, a herniated disc or a suspected herniation, please contact us using the following information:

Avicenna Clinic
Paulsborner Str. 2
10709 Berlin

Telephone: +49 30 236 08 30
Fax: +49 30 236 08 33 11
E-Mail: info@avicenna-klinik.de

You can call anytime, write an e-mail or fill out a callback form. Each patient then gets an appointment with a doctor of our clinic, who is a spine specialist (neurosurgeon). Based on MRI images (brought or made in our clinic) and on an in-depth examination, the doctor will discuss with you all the different therapy options or possibly surgery. You can also use our specialists only to obtain a (second) opinion.

If you decide to undertake your therapy and/or surgery in Berlin, we would want to make your stay as pleasant as possible. In our clinic, you are at the center of our attention! You can expect state-of-the-art equipment in all areas - from the operating room to the patient bedroom.

The latest, gentle, minimally invasive treatment procedures are the focus of our clinic. Together we try to find a suitable treatment for your complaints. The actual therapy takes place only after a detailed discussion with the patient, examinations and the diagnostics.

For us, as important as medical care, it is the commitment we take to guarantee our patients a high level of personal care that can, in turn, ensure them a comfortable stay.

During the period of inpatient stay our team of nurses will take care of you 24 hours a day. They also offer services in several foreign languages, including English, Russian, Polish, Turkish, Spanish, Italian, Arabic, Bulgarian and French. We care not only about your safety but also your needs, respecting traditions and religions.

Our team is made up of a group of highly qualified specialists who work together to guarantee you a quick recovery.