I just had the opportunity to travel to the American Society of Peripheral Nerve Surgery meeting that was held in San Diego this January. What an amazing group of people presenting their research and work to those interested in this field of peripheral nerve surgery. The meeting is always so encouraging. Let me state that there are some of the brightest minds in America that are working on many of the issues that we see as a peripheral nerve surgeon. Even in this relatively small group of people, the interests are extremely varied. They deal with problems of nerve regeneration, prevention of chronic pain, and restoration of function including sensation, and muscle function.
While some think this field as fairly small, in reality the work on the peripheral nerve affects every specialty from ophthalmology to orthopedic surgery, or head and neck, to gynecology. There were many take home highlights from this meeting that are particularly important in MY current practice.
Diabetic Peripheral Neuropathy
There is great hope for patients who suffer from diabetic peripheral neuropathy that have evidence of an overlying nerve compression in their legs. A 10 year follow up was presented from a randomized, placebo controlled surgical trial. Do you know what that means… this is the state of the art, highest level of evidence possible. It was an enormous undertaking by one of our fantastic colleagues Dr. Shai Rozen and his team at UTSW in Texas. The highlight… the effects of appropriately performed decompression of nerves in the feet of well controlled diabetics that suffer from painful feet and or loss of sensation are robust and long lasting, and provide significant improvement in quality of life, allow patients to get off of many of their medications, and restores sensation, and relieves pain. If this were the only thing that was presented at the entire meeting this would have been enough to celebrate. There continues to be hope for those suffering from Diabetes who have been diagnosed with diabetic peripheral neuropathy and who have evidence for nerve compression in their feet.
Patients With Pain After Amputation
We can help them! A lot! Many studies were presented from many different academic centers around the country that clearly demonstrated that we are getting better and better at helping CURE and even PREVENT pain in those patient’s that have undergone, or will have to undergo amputations of the upper and lower extremity. There is so much exciting news in this area. There are several techniques that seek to go to the source of the pain to address it directly to try to treat the underlying causes. These newer techniques are called Targeted Muscular reinnervation, Regenerative Peripheral Nerve Interfaces, and simple implantation into muscle or nerve grafting that have been shown in most appropriate patients to reduce both the phantom limb pain (pain that is perceived in the missing part), and also the residual limb pain (pain that remains in the residual limb that is left). This has been shown to decrease pain, improve quality of life, allow patients to wear their prosthetics, and take less medications. All without the need for spinal cord stimulators.
Neuroma Pain
Similar to the post- amputation pain, also more successfully treated than ever before with surgical techniques as mentioned above. Traumatic or surgically created neuroma pain in all locations.
- Arms
- Legs
- Trunk
- Pelvis
- Head and neck
Migraine Headaches
Wow the evidence just continues to grow and grow that those patients who have refractory, severe, chronic migraines can benefit substantially and in many circumstances be cured by surgical techniques to address the particular peripheral nerve trigger that is otherwise not successfully treated by Botox, medications, or other conservative therapy. Many surgeons Ziv Peled MD, Rob Hagan MD, Ivan Ducic MD and others, shared their continue outstanding experience in appropriate patients. Again plastic surgeons making headway into fields that have seemingly little to do with what most think of when they think of “plastic surgery.”
Preventing Blindness
One of our outstanding colleagues Greg Borschel MD (a rock star in the peripheral nerve world) has shown long lasting results in preventing blindness in patients who have lost all sensation to the cornea – the clear part of the eye that covers the lens. Essentially it is the window that allows light into the eye. Patients who have lost sensation to this area due to a variety of reasons will go on to have ulcerations, which lead to scarring, which leads to loss of light transmission, which leads to blindness. Vision can be restored if sensation to the cornea can be restored. He has shown that by borrowing nerves from other locations on the face and transposing them to the cornea with nerve grafts, sensation will be restored, protection from ulceration occurs, and sight is preserved. This is amazing --- who thought that it would be a plastic surgeon that was involved in protecting the gift of sight!!!
Other Advances
There were so many other amazing things happening in the world of peripheral nerve that were presented at the meeting that we do not typically see in our practice but are becoming more and more mainstream at some or our countries best academic centers.
- Robotic arms that move powered by the patient’s own nerves and muscles. Intuitively controlled.
- Restoring function to paralyzed limbs
- Restoration of function after devastating extremity trauma
- Improving nerve regeneration
- Restoring smiles to patients who have lost all function of their facial muscles
- This list goes on.
I just wanted to thank the movers and shakers of peripheral nerve surgery around the country who presented their incredible work in helping so many people improve the quality of their lives. I am so blessed to be a part of a community that so creative, so inventive, and is pushing the envelope in helping patients that have often been told that there is “nothing we can do to help.”
Bravo to the members of the American Society of Peripheral Nerve.