Nerve Surgery – Risks, Procedure, and Preparation

You may go on your nerves. The proverb tries to say that one might work at his or her convenience. This is because there is no standard to measure your own work. However, this freedom permits new kinds of forms that will not necessarily comply with the constraints of other genres.

And you must work properly, though your work might be as per your wishes. Though this proverb is very long, the nerve has been highlighted in it. Issues with nerves are risky, and nerve surgery is also complicated. Let’s take a look at the nerve surgery.

What is nerve surgery?

The process in which a healthy piece of nerve from a place in your body is taken and used to reconnect the two ends of the damaged nerves. The nerve surgery is done by a surgeon. The segment nerve is attached surgically to the damaged nerve to stuff the gap between its two ends.

After the nerve surgery, a person’s mobility is restricted for three weeks using a brace, splint, or sling. Generally, an overnight hospital stay is needed for the nerve surgery. 

After your surgeon checks you for a follow-up visit, you might be encouraged for the mobilisation and the beginning of the therapy services.

Nerve Surgery Procedure

It takes enough time and care to successfully complete a surgery. In such a way, the nerve surgery also requires proper execution, which involves many steps.

Here are the steps involved in the nerve surgery:

Nerve Surgery Preparation:

• During the patient evaluation, details about the patient, like the patient’s medical history, physical condition, and severity of the nerve damage through clinical examinations, imaging techniques (MRI, nerve conduction studies, CT scan), and electrophysiological tests, are thoroughly analysed.

• Next, the nerve suitable for the nerve graft options will be selected. According to the location and type of nerve injury, autografts (the patient’s own nerves), allografts (from a donor), or synthetic conduits might be used.

• A surgical team containing skilled and experienced people, including an anesthesiologist, a nerve surgeon, and nursing staff, will be formed. The hospital will make sure that all members of the surgical team know the specific details of the procedure.

Nerve Surgery Beginning:

Initially, the medical provider will give anaesthesia, like local anaesthesia with sedation or general anaesthesia, as per the patient’s needs and the risk of the surgery. 

The medical team will make a precise incision over the region of nerve damage, opening up the damaged nerve ends and the tissues encircling them.

Nerve Preparation:

• The proximal (closest to the spinal cord) nerve stump will be carefully dissected and isolated.

• The identification and preparation of the distal (at a longer distance from the spinal cord) nerve stump are undergone.

• Now, the nerve gap is measured between the proximal and distal nerve stumps. This measurement will help to choose an appropriate nerve graft or conduit length.

Nerve Surgery Procedure:

Here is the process used in the nerve surgery procedure.

• In an autograft, a suitable nerve graft from the patient (commonly the sural nerve) is taken to fill the nerve gap. Then, patch the graft ends to the proximal and distal stumps. In an allograft, the graft ends up at the nerve stumps, which are sewn carefully. Then, the cut place is sealed properly.

• Then, a synthetic nerve conduit between the nerve stumps will be inserted by the surgeon, and using sutures, it will be secured in place. 

• In microsurgery for nerve regeneration, the microstructures (fine stitches) are used to join the nerve stumps or graft ends properly.

• In hemostasis, the bleeding is controlled, and hemostasis (blood clotting) is confirmed to stop the complications.

• Make sure that you close the incision using suitable sutures or wound closure methods.

Dressing procedure:

• The medical team will assist you in dressing the wound. They will apply dressings to the surgical site and give proper instructions for wound care and dressing changes.

• Make sure that you immobilise the operated area with the help of the splints or braces to avoid the stress on the repaired nerve.

Nerve Surgery Risks

Nerve surgery also has some risks, like other types of surgeries.

• Similar to other types of surgeries, infection risk is the major risk in nerve surgery.

• Next, the donor nerve might have a small risk of injury, which could result in a partial loss of function.

• Also, in some cases, there is a probability that the nerve transfer is unsuccessful in mitigating your symptoms.

• If the treatment is unsuccessful, then your treatment options might be restricted in the future.

Types of Nerve Repair Surgery

There are many types of nerve surgeries that help repair damaged nerves and restore their function. They are :

1) Direct Nerve Repair

Direct nerve repair is a method by which the ends of the nerves can be connected back together. This is the first method a surgeon prefers if a nerve is cut sharply (e.g., using a glass or a blade).

The direct nerve repair procedure is performed by a skilled nerve surgeon. In this method, a surgeon might trim the damaged tissue initially at the ends of a nerve. Then, he or she will bring the ends closer and connect them with either of the techniques, like:

• Using special glue to connect the nerve ends together.
• Sewing the ends of the nerve together.

2) Nerve Grafting

A nerve graft is the method by which a gap between the ends of a damaged nerve is bridged in cases where the gap has less possibility of reconnecting. Some blunt or crush injuries and previously failed nerve repairs might lead a person to this condition.

In this method, a piece of nerve tissue is taken from a place of less importance and attached wherever it is needed. The nerve grafting method is the same as the grafting of skin or bone.

3) Nerve Transfer

In the nerve transfer method, a healthy and redundant donor nerve is redirected to bridge the damaged (non-functioning) nerve. A nerve transfer will be recommended by the surgeon if reconnecting the ends of a damaged nerve is not a wise choice.

The functions of the damaged nerve supply to the muscles and skin by the damaged nerve will be recovered as the nerve fibre regrows.

Who needs nerve surgery?

A person might need surgery to repair the nerves which are torn, compressed, stretched, or otherwise damaged and cannot be healed. The nerve surgery might be needed for the following causes:

• Some vehicle accidents involving high-speed vehicles, heavy vehicles, and machinery accidents involving blades, saws, etc., might result in a need for nerve surgery.

• A crash in the brachial plexus (the nerves that come from the spinal cord at the neck and pass into the arms and hands) might cause nerve damage. The brachial plexus damage might need nerve surgery.

• To remove a few types of nerve tumours, one might need nerve surgery. Some tumours can be removed through nerve surgery without injury to the nerve, while other cases might injure the nerve during the repair.

• Nerve entrapment is a condition in which a nerve is compressed by the tissues around it. Such conditions need surgery; in some cases, if the trapped nerves are needed, others could be repaired.

• A surgical nerve repair method will be performed if the nerve damage occurs due to any one of these conditions:

i) Ulnar nerve compression occurs in the arm nerves.

ii) Peroneal nerve compression in the knee region.

iii) Tarsal tunnel syndrome is a condition occurring in the nerves that pass through the ankle into the foot.

What not to do after nerve surgery?

The post-procedure instructions include many suggestions: 

• A patient who has undergone nerve surgery must not drive or operate machinery or vehicles for 24 hours after the procedure. This is due to the fact that the intravenous medication provided during the procedure might limit your ability to safely do the work. 

• You can start a structured rehabilitation programme, like physical therapy or occupational therapy. They could help promote nerve regeneration, bring back function, and stop muscle atrophy.

• Regular follow-up appointments can be scheduled. It helps in monitoring nerve regeneration, facing any risks, and modifying the rehabilitation plan as per the requirements.

• You can have a pain management plan. They will provide you with suitable pain management strategies to make sure that the patient is pain-free during the recovery period.

Nerve decompression surgery (Nerve release surgery)

Nerve decompression is a method that reduces the pressure on a nerve, which includes a nerve release. Nerve decompression surgery clears off the tissues or blood vessels that press, constrict, or irritate some nerves, which is the main cause of the migraine.

However, this surgery does not remove the skull bones. If those nerves have more space, then the surgeon adds additional padding (made up of fat) to every nerve. This will prevent migraines.

Unlike pills that you may take every day to prevent migraines, this surgery might stop the need for pills that temporarily stop the migraine.

How do nerves impact migraines?

Some chronic migraines might be triggered by irritated nerves, other than factors like caffeine, certain smells, too little sleep, etc. The nerves in your head or neck below your skin become compressed.

They may be squeezed by the muscles, surrounding tissue, and blood vessels. Due to the inadequate space, these constricted nerves might induce migraine headaches.

Differences between nerve decompression surgery and other nerve surgeries

Nerve decompression surgery helps remove the tissues or blood vessels that strain nerves and induce migraines. Other nerve surgeries, like nerve grafting, nerve transfer, etc., involve the recovery of the damaged nerves through reconnecting the nerve ends or placing a nerve suture for reconnection.

Conclusion

Nerve surgery is the process in which the two ends of the damaged nerves are reconnected. There are many nerve surgery methods, like direct nerve repair, nerve grafting, nerve transfer, etc., which will be chosen depending on the patient’s condition and severity.

The risks, procedure, and preparation of nerve surgery are also of huge importance, like other surgeries. The patient may follow the post-surgery precautions to make a speedy recovery. However, the nerve surgery is different from the nerve decompression surgery.

FAQs