What Causes Neuropathy?
Many types of neuropathy are caused by systemic diseases, the most common of which is diabetes. Patients who are "Pre-diabetic", those who are overweight with high cholesterol and high blood pressure exhibit diabetic neuropathy symptoms similar to that of diabetic patients. Other causes of neuropathy can include chemotherapy (Vincristine, Thalidomide, Taxol and Cisplatin are common chemotherapy medications that have been proven to cause neuropathy), certain forms of arthritis, thyroid disorders, leprosy, alcoholism, drug use, heavy metal toxicity, and vitamin deficiencies. Still there are many types of neuropathy in which the cause is not known. This is referred to as idiopathic neuropathy.
There are two main types of neuropathy the first of which is where the nerve itself has a problem with the body attacking the lining of the nerves. This is a small fiber neuropathy which cannot be treated with surgery. The second is a "Compressive Neuropathy" which is caused by pressure on the nerve similar to Carpal Tunnel Syndrome. This type of neuropathy may be corrected by surgically relieving the areas of compression on the nerves caused by the surrounding tissues. Diabetics and "pre-diabetics" most commonly have compression neuropathies. This is because in diabetics the nerves are swollen. When sugar (glucose) from the blood goes into the nerve it changes to sorbitol (another sugar). This chemical reaction causes a greater number of water molecules to enter the nerve causing swelling. The swollen nerves run through tight anatomical tunnels in the body. When swollen nerves are in tight tunnels they get compressed causing pain and numbness. By releasing the areas of compression (the tight tunnels) sensation can be restored and pain decreased. This is the same operation has been done for carpal tunnel syndrome for many years. The success rate of nerve decompression surgery for diabetic and "pre-diabetic" patients is in the eighty-percent range. Decompression of the nerves can reduce or eliminate pain, improve sensation and balance and prevent ulcerations and amputations.
Are There Non-Surgical Treatment Options for Neuropathy?
Patients should first consult their primary care doctor to determine if their type neuropathy is caused by an underlying disease that can be treated, such as a thyroid disorder, vitamin deficiency or diabetes. Treatment of the disease can frequently provide relief for the symptoms. Some anesthesia pain management doctors have medical treatment options for those patients who are not healthy enough to undergo surgery or for those who are not good surgical candidates.
Who Is A Candidate For Neuropathy Surgery?
Surgery is an option once it is determined that your neuropathy is a "Compression Neuropathy" and that you are a good candidate for surgery. Dr. Maloney and his staff will use the PSSD (pressure specified sensory device) 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. Maloney will also examine you for a "Tinels Sign" to determine whether there might be signs of compression over the nerves. Patients who are under the age of 75 that are in good health with abnormal PSSD test results and a positive Tinels sign are typically good surgical candidates.
What Can I Expect During and After Neuropathy Surgery?
Nerve decompression surgery is an outpatient procedure that takes about an hour. A general anesthetic is administered by an Anesthesiologist using microsurgical techniques Dr. Maloney makes three incisions, one on the top of the foot, one up by the knee on the outside of the leg and one on the inside of the ankle. Once Dr. Maloney finds the nerve, he follows it to the area of compression and releases the tight band (the top of the tunnel) that is compressing the nerve, similar to what is done during carpal tunnel surgery. THE NERVE ITSELF IS NOT CUT OR DAMAGED. After Dr. Maloney completes the operation, a simple compressive dressing is placed on the leg and the patient is transferred to the recovery room. There are some patients that notice an immediate difference in there pain as they wake up in the recovery room, others it can take up to several months depending on the amount of compression and the degree of nerve damage from the compression. The patient is sent home and asked to use a walker or crutches for the first week to minimize the amount of pressure placed on the operative leg. After the first week the dressing is removed and the patient may get back into a normal shoe and sock. The final sutures are removed 2-3 weeks after surgery and at this time the patient is released to normal activity. Patients are allowed to immediately walk on the operated leg but we try and limit activity and bending at the ankle to allow proper wound healing.
As the nerves regenerate and grow 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.
Are There Any Risks Involved With Neuropathy Surgery?
The biggest risk with this operation is that patients may still be left with areas of pain or numbness or there might be no change at all in the amount of numbness and/or pain. The most common risks associated with any type of surgical procedure include minor infections and scaring. Certain medical conditions, such as diabetes, may slow the healing process increasing the risk of infection. Other risks include an increase in pain (which is usually the progression of the neuropathy and not an operative complication) or DVT which are very uncommon.
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Call 520.298.2330 if you have any questions regarding the information above, or fill out the form in the sidebar to ask Dr. Maloney any questions you have.