Nearly 20 million Americans suffer from neuropathy (neuro=related to the nerves; pathy=disease), a chronic condition that results from damage to or compression of the nerves outside the spinal cord and brain. Also referred to as peripheral neuropathy, the disorder can manifest in different forms, such as mononeuropathy when only one nerve is affected, or as polyneuropathy when many nerves are involved, often symmetrically, on both sides of the body. Symptoms include pain, numbness, tingling and weakness of the affected extremity.
The peripheral nervous system is a network of 43 pairs of motor and sensory nerves that connect the brain and spinal cord (the central nervous system) to the entire human body. These nerves control the functions of sensation, movement and motor coordination.
The peripheral nervous system sends messages from the brain and spinal cord to the arms and hands, legs and feet, internal organs, joints and even the mouth, eyes, ears, nose, and skin. Peripheral nerves also relay information back to the spinal cord and brain from the skin, joints and other organs. Peripheral neuropathy occurs when these nerves are damaged or destroyed, resulting in a variety of symptoms.
Three main types of nerves can be involved in peripheral neuropathy. Impaired function and other symptoms depend on which of the three types of nerves are damaged: motor, sensory, autonomic or a combination of any of those three.
Neuropathy is not a single disease. Instead, it is a complication found in a number of different underlying medical conditions. More than 100 types of peripheral neuropathy have been identified, each with its own particular set of symptoms, pattern of development and prognosis.
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In one such study from 2005, conducted at Division of Neurosurgery, Department of Surgery, University of Arizona, Tucson, researchers followed outcomes from 100 consecutive nerve decompression surgeries for neuropathy. The study concluded that decompression of compressed lower-extremity nerves improves sensation and decreases pain, and should be recommended for patients with neuropathy who have failed to improve with traditional medical treatment. (Source: **http://www.ncbi.nlm.nih.gov/pubmed/16166462)
Q&A with Dr. Rose
Dr. Michael Rose is an expert in nerve decompression surgery for people suffering from all forms of neuropathy, with an emphasis on undertreated lower extremity neuropathy. Experienced in various forms of microsurgery, he is one of a select number of plastic surgeons trained in the nerve decompression technique.
Dr. Rose is Chief of the Division of Plastic Surgery at Jersey Shore University Medical Center. He is also a member of the Center For Treatment of Paralysis and Reconstructive Nerve Surgery at Jersey Shore Medical Center, which provides some of the most advanced surgical treatment of paralysis and nerve injuries in the world today.
Putting Out the House Fire
Solutions for Neuropathy
How long have you been doing neuropathy surgery, and what types of neuropathy have comprised the majority of that surgery?
I’ve been performing this surgery since 2004 with various types of neuropathy. The three most common causes of neuropathy I treat are probably diabetic neuropathy; followed by chemotherapy-induced neuropathy; and finally idiopathic (unknown cause). I’ve also treated a variety of other types, such as alcohol-related neuropathy and neuropathy caused from obscure medications. All types of neuropathy seem to respond similarly to this surgery.
What is the background of decompression surgery for neuropathy?
The most well-known and accepted neuropathy surgery is for carpal tunnel syndrome, cubital tunnel syndrome or other conditions of the upper extremity. Surgeries performed on the lower extremities are not widely known since generally this area has been ignored by the medical community. People tend to assume that when their feet hurt, it’s because they’re getting older and their feet are supposed to hurt. They don’t realize there is something they can do about it. For this reason, I developed a subspecialty in this surgical area which applies the knowledge we have of decompression surgery for the upper extremity to the lower extremity.
What are your general results with this surgery, and what do you conclude from them?
Approximately half of patients who are deemed eligible candidates for this surgery will experience measurable improvement in their quality of life, with a reduction in symptoms of pain and tingling. However, it is very difficult to predict who will be eligible and potentially benefit from the procedure until a person comes in and has a thorough evaluation.
I routinely see people who have had neuropathy of a lower extremity for 10 to 15 years. It is ideal if they come in between one and three years after the onset of their issues. I think this could likely raise the overall success rate of this surgery to 75 percent. The shorter the time the nerve is compressed, the less damage the nerve suffers. With a longer wait for treatment, it can be difficult, if not impossible, for the nerve to recover. I equate it to a house fire. If you can put out a small fire, you can easily rebuild the house. If the fire keeps burning, it destroys the house, including the foundation. At some point the house is gone and you can’t recover from it. Obviously, we prefer to see people before this is the case.
Can you explain the basic process or mechanism of this surgery?
I open the various areas on the leg (or arm) where the nerve is most susceptible to being entrapped or pinched. We know where these places are, as they are the same in almost everyone. I release the nerve from the surrounding structure so that it is able to recover. This procedure is a relatively minor outpatient (one day) surgery. It takes about 45 minutes to do one leg, and patient recovery takes about a week. Results are not generally immediate, but I have had some patients who did get immediate relief. It may take some months to a year or even more for the nerve fibers to grow back, and a person begins to get normal feeling and the pain is reduced.
What are the consequences of neuropathy? Is it dangerous?
Neuropathy affects the quality of life, but it also has other consequences. People with neuropathy have many more fractures, such as broken hips. Many times people can’t feel their feet, so balance is impacted and thus they are much more likely to fall and break a bone. Also, they don’t notice cuts, which can become infected. They can lose toes. Correcting the neuropathy results in reduced orthopedic fractures, infections and amputations.
Who are good candidates for this surgery, and how are they evaluated?
The rules for being a good candidate for any surgery apply. People should be in reasonably good general health with adequate blood flow down to the feet. They should also be of reasonable weight, since obesity interferes with wound healing. Candidates should generally be under age 65, since after that age the nerves usually do not regenerate (grow back). They should also have had neuropathy for fewer than 10 years. In my evaluation, I do a complete medical history and order tests, such as a nerve conduction study. If a person fits all the criteria, I offer to do the surgery.
Meet the Neuropathy Specialist
Dr. Michael Rose, Chief of the Division of Plastic Surgery at Jersey Shore University Medical Center, is an expert in reconstruction following cancer surgery or deforming accidents.
He is particularly skilled in complex nerve decompression surgery for people suffering from all forms of neuropathy, and is one of only a handful of plastic surgeons specifically trained in this technique.