Improving Nerve Recovery After Repair or Decompression Through Brief Intraoperative Nerve Stimulation
Jovito Angeles, MD; Jimmy Jiang, MD; Jonathan Twu, MD
University of Chicago, Chicago, IL
Introduction: Recent studies have demonstrated acceleration of nerve recovery and improvement in functional outcomes in subjects receiving electrical stimulation (ES) during or immediately after nerve repair/decompression. We report our outcomes in thirteen patients who received intraoperative nerve ES using an off-the-shelf handheld device.
Materials & Methods: We retrospectively reviewed the records of 13 patients who underwent nerve decompression or repair with ES during surgery. Patient demographics, surgical findings, pre- and postoperative functional evaluation (monofilament test, manual muscle test, grip and pinch measurements), and electrodiagnostics were analyzed. During surgery, the nerve was exposed proximal to the level of compression or injury and received 1 hour of continuous stimulation at supramaximal (0.5 to 2 mA) intensity using an off-the-shelf handheld stimulator while nerve decompression/repair was performed distally. Reconstruction or decompression was performed using conventional microsurgical techniques based on clinical indications.
Results: Three female and ten male patients received 1 hour ES during surgery. The average age at surgery was 46 years (Range: 12-76 years), interval from injury/onset of symptoms was 45 weeks (Range: 8 days-4 yrs), and follow up 9.8 months (Range: 4-19 mos).Nerve involvement were suprascapular and axillary nerve: 1, Median nerve: 4, Ulnar nerve: 5, and sciatic nerve: 3. The etiology was traumatic in 8 and non-traumatic/compressive neuropathy in 5. All patients with non-traumatic etiology underwent decompression with one patient undergoing end-to-side AIN to ulnar nerve transfer. In patients with traumatic etiology, one had decompression and nerve transfer, 4 had neuroma excision with cable grafting, 2 had primary repair, and 1 underwent neurolysis. All but two patients demonstrated improved sensation documented by monofilament test and manual muscle test at rates that appear to be faster than expected for the lesion. Two patients who suffered gunshot injuries to the sciatic nerve recovered functional strength in the posterior leg compartments but not in the anterior. One of these had surgery at 24 months after injury.
Conclusion: Use of brief intraoperative ES showed promising results in our series with no complications from the use of stimulation. As in patients undergoing conventional repair, patients who had delay in treatment, proximal lesions and high-energy injuries appear have slower recovery and worse functional outcomes despite ES. Larger, well-controlled trials are needed to study the interaction of patient factors, surgical technique, and neural pathology with ES and their effect on nerve recovery.
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