Why does pain return after a "successful treatment"?

Surgery succeeded - but pain returns after an initial relief. How can that be possible? What was wrong?! Of course nothing was wrong! It's just nature that sometimes has its own laws. We talk about scarring, adhesions or fibrosis. Adhesion - 'adhere' means to stick to something. These adhesions are not painful per se, but they can be the cause of a lot of different forms of pain. The problem caused by adhesions after surgery has a name: postnucleotomy syndrome.

You have to imagine that these adhesions are created deep in the surgical field around the nerve root and meninges (dura mater). As a result, blood circulation and cerebrospinal fluid circulation worsen surrounding the nerve root and holding it tight. This is followed by pain, discomfort and even deficiencies. Scars around the nerves are the main cause of pain after or despite "successful" surgery on the spine. In fact, adhesions are most often the result of a surgical procedure. Although the herniated disc has been removed, or although the spinal canal has been enlarged, patients continue to feel pain or to complain. This is what physicians call the "post-nucleotomy syndrome".

Post-nucleotomy syndrome after herniated disc surgery

International studies have shown that adhesions after surgery are more common than we would think. The so-called post-nucleotomy syndrome affects about 10%of all patients who have undergone disc surgery. In two-thirds of those affected, causes like scarring or adhesions around the nerve root in the surgical field are more visible in MRI examinations.

The anti-scar gel is an adhesion barrier

What can we do to relieve us from pain? Is it possible to do anything, or does the patient have to accept the pressure that adhesions put on the nerves structures? 

Of course something could be done. In order to prevent a renewed affection of nerve roots accompanied by pain, in the Avicenna Clinic we use the so-called anti-scar gel, which ideally makes the formation of adhesions impossible. The anti-scar gel is also-called “adhesion barrier.”

And that is how it works. Immediately after the surgical procedure, immediately after the removal of the lesion, or after dilation of the nerve canal (that's to say before we close the wound), we inject a clear anti-scar gel around the dura mater and around the nerve root, using a very fine cannula and cover the tissue with the gel. The process of scarring begins just right after the surgery ended, that´s why the anti-scar gel application is immediate. The gel is not only very effective, but also biodegradable. Within a few months, the gel dissolves in the area where adhesion would almost certainly have occurred.

Is that a miracle? No! - But a very effective remedy! It always contains active ingredients - including calcium - that support normal wound healing. In other words, it helps to build a mechanical barrier to pinpoint so-called inflammatory mediators. Inflammatory mediators are the body's own substances which initiate or sustain the inflammatory reaction of a tissue. Among the inflammatory mediators include low molecular weight compounds such as histamine, serotonin, prostaglandins and leukotrienes.

What advantages do I have? What complications must I fear?

Complications are unknown. Benefits, on the other hand, are not only individually felt, but also confirmed by patient’s examinations. There were two groups of patients - one group treated with the anti-scar gel, the other not. While 30% of untreated patients complained of pain six months after the 'successful' operation, which were just as minor as before the procedure, the anti-scar gel group confirmed pain relief and even freedom from pain, no numbness and no discomfort. On questionnaires, all patients had given their answers on the subject of quality of life after the operation.

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.