Nerve surgery is performed as an outpatient procedure taking about an hour. Appropriate anesthesia is administered by an Anesthesiologist. Using microsurgical techniques, Dr. Klein finds the damaged area of the nerve, cuts it out and buries or implants the healthy end into a muscle. A surgical dressing is applied at the end of surgery. Some patients notice an immediate difference in their pain in the recovery area and for others it may take months. Postoperative care is followed closely by Dr. Klein. As in all nerve surgery risks do exist. Risks are similar to neuroma excision with the added caveat that some patients continue to have pain and their body never responds to the removing of the nerve. These patients have "centralized pain" which means their pain doesn’t respond to the procedures on the nerve itself and instead these patients require the expertise of pain management specialist.
Many types of neuropathy are caused by systemic diseases, the most common of which is diabetes. Patients who are " Pre-diabetic", are those who are overweight with high cholesterol and high blood pressure. They will exhibit neuropathy symptoms similar to those with diabetes. Neuropathy causes include chemotherapy, certain forms of arthritis, alcoholism, vitamin deficiencies, thyroid disorders, drug use, heavy metal toxicity (lead) and leprosy. Many types of neuropathy have no known cause and these are referred to as idiopathic neuropathy.
Two main types of neuropathy exist. The first involves the body attacking the lining of the actually nerves. This small fiber neuropathy is not amenable to surgery. The second is a "Compressive Neuropathy" commonly seen in Carpal Tunnel and Tarsal Tunnel Syndrome. This type of neuropathy can be corrected surgically by relieving the areas of compression on the nerves by the surrounding tissue. Diabetics and "pre-diabetics" most commonly have these neuropathies because their nerve are swollen. Abnormally high sugar (glucose) has the affect of increasing water molecules to enter nerve tissue thereby causing the nerve to swell. As the nerves wind their way down through anatomic tunnels they get compressed thereby producing loss of sensation. Thus multiple nerves can produce numbness in a "stocking and glove" distribution about the foot and leg. By releasing the areas of compression sensation can be restored and pain decreased. The success of this operation is approximately 80%.
Dr. Klein and his staff will use the PSSD (pressure specified sensory device) in the office to measure the function of your nerves. This is a non-painful and non-invasive test that quantifies the sensory loss of the nerve. Dr. Klein will also examine you for a "Tinels Sign" to determine whether there might be signs of compression over the nerves.
Recent literature has shown that small nerve neuropathy is diagnosed successfully by a 3 mm biopsy of skin from the outer leg. Patients under the age of 75 that are in good health with abnormal PSSD results and a positive Tinels sign are typically good surgical candidates.
Nerve decompression surgery is performed on an outpatient basis which takes about two hours. A general anesthetic is administered by an Anesthesiologist. Using microsurgical techniques Dr. Klein makes three incisions, one on the top of the foot, one up by the knee on the outside of the leg and one inside the ankle. Once Dr. Klein finds the nerve, he follows it to the area of compression and releases the tight band compressing the nerve. THE NERVE ITSELF IS NOT CUT OR DAMAGED. Upon completion of the surgery a compressive dressing is applied. A walker or crutches is recommended for the first week to relieve pressure on their surgical leg. The dressing is removed after the first week and a shoe with socks permitted. Final sutures are remove 2-3 weeks after surgery. Some physical activity limitations are encountered during the first 3 weeks,
As the nerves regenerate and grow back some patients may experience neuro-regenerative sensations such as shooting, stabbing or electrical types of pain. This is a good sign showing the nerve is growing. As the nerve continues to grow, the numbness the patient had before surgery will improve and the neuro-regenerative pain will improve.
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