How To Repair Nerve Damage After Surgery

Nerve Damage After Surgery: What Are Your Treatment Options?

In this commodity:

Overview
Diagnosis
Recovery fourth dimension
Treatments
Nerve damage patients' stories

One of the biggest issues nosotros see afterward surgery is scarring around the nerves (1). The nigh mutual symptoms of nerve damage after surgery are usually numbness, tingling, burning, muscle weakness or atrophy. Many times the symptoms are temporary, for example, many patients have nerve problems after surgery that just last for a few weeks to months (2,3). If they last longer than a few months, so they're placed into the permanent nerve damage category and volition likely need to be treated.

What Happens When Your Nerves Are Damaged?

Think of a nerve as a garden hose. If yous constrict one surface area, less water comes out. This is what happens when scar tissue forms around a nerve after surgery. The scar tissue constricts the nerve which reduces the transport of critical chemicals that the nerve needs to stay good for you.

A nerve can besides exist damaged by killing some or all of its fibers. The paradigm below shows that a nerve is made upwardly of bundles of neurons (nerve cells) chosen fascicles. Groups of these fascicles make upward the bigger nerve (four). In add-on, the nerve is surrounded by a fatty sheath (myelin) that acts similar an insulator roofing a wire. When this sheath gets damaged there can also be a problem with nerve office.

Anatomy of a nerve including a cross section.

Alila Medical Media/Shutterstock

There are three types of nerve harm:

Neurapraxia: damage to the covering of the wire, or myelin sheath
Axonotmesis: damage to the wire itself, or the neurons
Neurotmesis: the nervus is torn or cut in half

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How Common Is Nerve Damage After Surgery?

Somewhere between 0.5% and 2% of patients will have permanent nervus damage after surgery. Temporary nerve injury is much more common, especially in spine surgeries. See beneath for the nerve-related side effects of several common procedures:

Hip replacement: 0.2% to 0.half-dozen% (five)
Depression back fusion surgery (transient nerve injury lasting less than three months): 50% to 62% (2,3)
Shoulder replacement surgery: 21% had temporary nervus damage, two% had permanent nerve damage (6)

What Tests Testify Nerve Impairment?

There are a few tests to consider if you or your physician doubtable nerve damage later on surgery:

EMG/nerve conduction report

This is an electrical examination of the nerve's role. One event is that information technology is highly specific simply has low sensitivity. This means that information technology will usually simply pick up nervus harm that is more severe (7).

Ultrasound imaging of the nerve

This test can make up one's mind if the nerve size shows swelling and/or constriction. Information technology works nigh as well as a nerve conduction study and is less invasive (viii).

MR neurography

This is a very specialized MRI scan that'due south tuned to evidence the nerves (9).

How Long Does Information technology Take for Nerves to Repair After Surgery?

Most episodes of nerve impairment after surgery concluding for a few weeks to a few months. If they concluding longer, then the rate of nerve regrowth is about an inch a calendar month. Therefore, if the nerve is able to regrow, a nervus injury in the back could take years to regenerate the entire nerve from your back to your foot (10). However, many times scarring in or around the nerve prevents regrowth (11).

Learn about Regenexx procedures for spine conditions.

What Helps With Nerve Pain After Surgery?

Treatment options for nerve impairment and pain after surgery include:

Orthobiologics (e.k. platelet-rich plasma — PRP)
Physical therapy may assist.
Medications that are usually used to care for nerve damage afterwards surgery include:
- Neurontin (Gabapentin) (12)
- Lyrica (Pregabalin) (13)
- Elavil (Amitriptyline) (xiv)
- Topomax (Topiramate) (15)
- Ultram (Tramadol) (15)

Ultrasound-Guided Nerve Hydrodissection With Orthobiologics

How can you lot interruption upward scar tissue around nerves? Obviously, since the scar tissue was caused past surgery, using surgery to get rid of it tin be a problem. However, there'southward a new way to help nerves heal and become rid of the scar tissue called ultrasound-guided nervus hydrodissection with orthobiologics. In this procedure, a nerve is visualized with ultrasound. This is used to guide a small needle to inject fluid around the nerve to break up the scar tissue.

In this process, which builds off our published work on treating spinal nerves with platelets, we inject the patient'due south own platelet-derived growth factors that can assist nervus repair through cytokines like NGF, PDGF, and IG-1 (17,18). To encounter how this works on the median nervus in the carpal tunnel, meet the video that follows.

Does this piece of work? I embrace two cases below.

Tanya's Story

Tanya had a plastic surgery process on her gluteal area and ended up with a severe infection that caused scarring around the sciatic nerve. This basically gave her a dead leg. Then when I met her she was wearing a special brace to walk and had significant numbness and severe pain down the leg. She could barely go up or downward a flying of stairs. I performed the ultrasound-guided nerve hydrodissection with orthobiologics procedure a total of 4 times over the grade of a year. I treated the entire length of the nerve, starting in the low back using fluoroscopy guidance, then turning to ultrasound-guided injections to treat the sciatic nervus down to the tibial and peroneal branches in the leg and pes. Where is she today? She no longer wears the brace, has gotten sensation back, and has limited hurting. She does 30-inch box jumps in CrossFit and is planning on competing in a bodybuilding contest!

>> Find out how Tanya is doing in 2022.

Ivy'southward Story

Ivy had a bad Four stick in her hand during which they injured the cutaneous co-operative of the ulnar nerve. Regrettably, she developed complex regional pain syndrome (CRPS) type 2 with hurting so astringent that she couldn't accept anyone bear upon the hand nigh days. This made it very difficult to work with kids as a nurse practitioner, as they oft grabbed that hypersensitive hand.

I performed the ultrasound-guided nervus hydrodissection with orthobiologics procedure a total of iv times over about a year, injecting all around the fretfulness in the mitt, the ulnar nerve at the wrist and elbow, and the nerves in the cervix. Her grip strength went from negligible to normal. Today she has very little pain most days and can see kids without a problem. This is specially remarkable considering there are so few treatment options for patients one time severe CRPS sets in.

The result? Nervus damage after surgery that doesn't go away afterward a few months can be devastating. Yet, newer nonsurgical nervus repair techniques may be able to help.

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References

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(2) Liang JQ, Chen C, Zhao H. Revision Surgery after Percutaneous Endoscopic Transforaminal Discectomy Compared with Primary Open Surgery for Symptomatic Lumbar Degenerative Disease.Orthop Surg. 2022;11(4):620–627. doi:10.1111/os.12507

(three) Mueller K, McGowan J, Kane S, Voyadzis JM. Evaluation of retraction fourth dimension equally a predictor of postoperative motor dysfunction subsequently minimally invasive transpsoas interbody fusion at L4-L5. J Clin Neurosci. 2022 Mar;61:124-129. doi:10.1016/j.jocn.2018.ten.108

(4) King R. Microscopic anatomy: normal structure. Handb Clin Neurol. 2022;115:7-27. doi:x.1016/B978-0-444-52902-two.00002-three

(5) Fleischman AN, Rothman RH, Parvizi J. Femoral Nervus Palsy Following Total Hip Arthroplasty: Incidence and Course of Recovery. J Arthroplasty. 2022 April;33(4):1194-1199. doi:10.1016/j.arth.2017.10.050

(6) Lädermann A, Lübbeke A, Mélis B, Stern R, Christofilopoulos P, Bacle G, Walch Thousand. Prevalence of neurologic lesions later total shoulder arthroplasty. J Bone Joint Surg Am. 2022 Jul 20;93(14):1288-93. doi:10.2106/JBJS.J.00369

(7) Khambati FA, Shetty VP, Ghate SD, Capadia GD. Sensitivity and specificity of nerve palpation, monofilament testing and voluntary musculus testing in detecting peripheral nerve aberration, using nerve conduction studies as gilded standard; a study in 357 patients. Lepr Rev. 2009 Mar;80(ane):34-l. https://www.ncbi.nlm.nih.gov/pubmed/19472851

(8) Emril DR, Zakaria I, Amrya M. Agreement Between High-Resolution Ultrasound and Electro-Physiological Examinations for Diagnosis of Carpal Tunnel Syndrome in the Indonesian Population. Front Neurol. 2022;10:888. doi:10.3389/fneur.2019.00888

(9) Schwarz D, Kele H, Kronlage Thousand, Godel T, Hilgenfeld T, Bendszus 1000, Bäumer P. Diagnostic Value of Magnetic Resonance Neurography in Cervical Radiculopathy: Plexus Patterns and Peripheral Nerve Lesions. Invest Radiol. 2022 Mar;53(3):158-166. doi:10.1097/RLI.0000000000000422

(10) Recknor JB, Mallapragada SK. Nerve Regeneration: Tissue Engineering Strategies. In Bronzino JD (ed.). The biomedical engineering handbook (third ed.). Boca Raton, Fla.: CRC Taylor & Francis.

(11) Zhang H, Uchimura M, Kadomatsu Chiliad (November 2006). Encephalon keratan sulfate and glial scar germination. Ann N Y Acad Sci. 1086(1):81–90. doi:10.1196/register.1377.014

(12) Griggs RB, Bardo MT, Taylor BK. Gabapentin alleviates affective hurting after traumatic nerve injury. Neuroreport. 2022;26(9):522–527. doi:10.1097/WNR.0000000000000382

(thirteen) Khan J, Noboru N, Imamura Y, Eliav E. Effect of Pregabalin and Diclofenac on tactile allodynia, mechanical hyperalgesia and pro inflammatory cytokine levels (IL-six, IL-1β) induced past chronic constriction injury of the infraorbital nerve in rats. Cytokine. 2022 Apr;104:124-129. doi:10.1016/j.cyto.2017.10.003

(14) Matsuoka H, Suto T, Saito S, Obata H. Amitriptyline, only Not Pregabalin, Reverses the Attenuation of Noxious Stimulus-Induced Analgesia After Nervus Injury in Rats. Anesth Analg. 2022 Aug;123(2):504-x. doi:10.1213/ANE.0000000000001301

(15) Codd EE, Martinez RP, Molino Fifty, Rogers KE, Rock DJ, Tallarida RJ. Tramadol and several anticonvulsants synergize in attenuating nervus injury-induced allodynia.Pain. 2008;134(iii):254-262. doi:ten.1016/j.pain.2007.04.019

(sixteen) Centeno C, Markle J, Dodson E, et al. The use of lumbar epidural injection of platelet lysate for treatment of radicular hurting. J Exp Orthop. 2022;4(one):38. doi:ten.1186/s40634-017-0113-five

(17) Sowa Y, Kishida T, Tomita Chiliad, Adachi T, Numajiri T, Mazda O. Involvement of PDGF-BB and IGF-1 in activation of human Schwann cells by platelet-rich plasma. Plast Reconstr Surg. 2022 Aug 27. doi:10.1097/PRS.0000000000006266

(18) Sánchez M, Anitua E2, Delgado D, Sanchez P, Prado R, Orive G, Padilla South. Platelet-rich plasma, a source of autologous growth factors and biomimetic scaffold for peripheral nerve regeneration. Proficient Opin Biol Ther. 2022 Feb;17(2):197-212. doi:10.1080/14712598.2017.1259409

This article was originally published on October xi, 2022 and updated on April 7th, 2022.

Chris Centeno, MD is a specialist in regenerative medicine and the new field of Interventional Orthopedics. Centeno pioneered orthopedic stem cell procedures in 2005 and is responsible for a large amount of the published research on stalk jail cell employ for orthopedic applications. View Profile

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