Hope for Neuropathy
Nerve decompression surgery offers treatment for symptomatic neuropathy.
Many people react with skepticism when hearing that surgery can relieve the pain of neuropathy. Why haven't we heard about this before? Even though it is a relatively novel surgical procedure, it has been performed for over 15 years and is based upon principles learned from more commonly performed operations which surgeons have been performing for decades. Moreover, the results can be life-changing and important for dLife community members to consider.
Have you ever had a pinched nerve or had your arm fall asleep after laying on it? If that's all you've had, consider yourself lucky. How long would it take for your arm to wake up if you had fallen asleep on the nerves for a few years? What if the pressure on your arm nerves continued—would the arm ever wake up? For many people with diabetes, this is the manner in which their nerves become injured and is the reason the symptoms of neuropathy appear. Neuropathy caused by uncontrolled diabetes can be very painful and in severe cases, debilitating. Treatment options typically focus on medications that reduce the painful symptoms while the root cause of the problem, pressure on the nerve, continues (see related article about neuropathy by clicking here).
That was until Dr. Ziv Peled enlightened us with the latest surgical treatment options. Dr. Peled is Director of The Dellon Institute for Peripheral Nerve Surgery and Plastic Surgery in San Francisco, California. He gave a recent educational program on surgical nerve decompression for the Center for Diabetes Services staff at California Pacific Medical Center in San Francisco, California. Dr. Peled explained that the body has many known nerve compression sites where nerves pass through tight tunnels (fascial bands). If the nerves swell within the fixed space of these tunnels (as is the case of people with diabetes), the nerves effectively become compressed or entrapped and the symptoms of neuropathy rear their ugly heads. Common sites include, but are not limited to:
- The median nerve (wrist), which may get caught in the carpal tunnel (i.e. carpal tunnel syndrome).
- The ulnar nerve (elbow), which may get caught in the cubital tunnel.
- The radial sensory nerve (arm), which may get caught in the dorso-radial forearm.
- The radial nerve (just past the elbow), which may get caught in the radial tunnel.
- The common peroneal (knee), which may get caught near the fibular head.
- The superficial peroneal nerve, which may get caught approximately 12 cm above the outside ankle bone.
- The deep peroneal nerve, which may get caught in the dorsum (top) of the foot.
- The distal tibial nerve, which branches to give the medial/lateral plantar nerves (providing sensation to the bottom of the foot), and the calcaneal nerves (providing sensation to the heel region), which may get caught in the tarsal tunnel (behind the inside ankle bone).
Anatomical jargon aside, you can see we have a lot of places along a nerve's path in which these nerves can become entrapped. A nerve that is wrapped up and bound may result in pain and/or decreased sensation, which lead to a higher risk for ulcers, wounds and potentially the need for amputations. The further out the nerve is from the spinal cord, the higher the rate of nerve problems (e.g. the feet are more often involved than the thighs).
Dr. Peled shared his research and multiple cases of surgically released nerves with a resulting dramatic improvement in pain and sensation. If tight compressive band is cut, the nerve can go on doing its job.
Not everyone is a surgical candidate. The first step is to be examined so that your doctor can check if the nerve is still able to function (the Tinel sign). In addition, a sophisticated type of neurosensory testing is used to corroborate the severity of nerve dysfunction. This testing with the Pressure Specified Sensory Device (PSSD), detects exactly how much pressure is required to elicit a sensation of being touched. The PSSD has been demonstrated to be more sensitive than a needle conduction study (i.e. EMG) and best of all, is completely painless (needle conduction studies are painful—trust me).
How long is the surgery?
Surgery is usually about a 2-hour outpatient procedure. One extremity (arm or leg) is done at a time; as soon as six weeks later, the other lower extremity can be done. Patients can use their extremity immediately after surgery (walk, use their arm). Many insurance plans cover the procedure.
What kinds of surgeons perform this procedure?
Specialized plastic surgeons who have completed at least a six-month fellowship in peripheral nerve surgery are the most qualified to perform surgical nerve decompression for diabetic neuropathy, a procedure pioneered by Dr. Lee Dellon. For example, after completing his plastic surgery training at Harvard University, Dr. Peled spent an entire year studying these procedures at the Dellon Institute in Tucson, Arizona. Dr. Dellon is an accomplished plastic surgeon as well as a professor of Plastic Surgery and Neurosurgery at the Johns Hopkins University School of Medicine in Baltimore, Maryland. The Dellon Institutes for Peripheral Nerve Surgery owe their name to him.
Where can I have this done?
To date, this surgery is only available in San Francisco, Tucson, St. Louis, Boston, New York, Tennessee, and Baltimore. For more information, check out www.dellon.com and click on the "contact us" link on the left side of the home page. The clinical results are promising so perhaps this vital procedure will be more widely available in the near future.
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NOTE: The information is not intended to be a replacement or substitute for consultation with a qualified medical professional or for professional medical advice related to diabetes or another medical condition. Please contact your physician or medical professional with any questions and concerns about your medical condition.
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