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Peripheral Nerve Surgery

By Wendy Sweet

Photography by Martha Lochert

As featured in Tucson Lifestyle, January 2005

Peripheral nerve surgery - it's not a term that just rolls off your tongue. But if you or someone you know suffers from pain in your feet or joints, peripheral nerve surgery could be a life changing experience. As many people with diabetes can tell you from first hand experience, one of the most common complications of diabetes is neuropathy -- which affects the peripheral nerves and leaves you with numbness or tingling in your fingers or toes.

One local team of physicians believes that they have the answer for peripheral nerve problems.


The Cause...the Cure?

Peripheral nerve surgery is the brainchild of A. Lee Dellon, M.D, the director of the Institutes for Peripheral Nerve Surgery in Tucson and Baltimore. A professor of plastic and neurological surgery at Johns Hopkins University and a clinical professor of plastic surgery, neurosurgery and anatomy at the University of Arizona, Dr. Dellon has pioneered nerve decompression procedures to restore sensation and relieve pain in the lower extremities, especially in patients with diabetic neuropathy.

"Peripheral nerves are all the nerves in the body that are outside your brain and spinal cord," explains Dr. Dellon. "These nerves give us feeling in our hands, feet and face. They are how we interface with our environment; these nerves tell us about movement and pressure, hot and cold and pain. A disease that affects peripheral nerves can be called a neuropathy," he says. "If the nerve is choked or pinched, it doesn't get enough oxygen. The nerve makes you aware of this lack of oxygen by sending you a warning message. The symptoms of neuropathy can be pain, a tingling or buzzing sensation or numbness. The most common cause of neuropathy is diabetes."

However, Dr. Dellon is quick to point out that diabetes is not the only cause. "Other diseases that can give you neuropathy include thyroid problems, vitamin deficiencies, alcoholism, and some kinds of arthritis. Some of the chemotherapy drugs given to cancer patients can also cause neuropathy " particularly Taxol and compounds that contain platinum," he notes. There are also many patients with an undetermined cause. "In the United States there are equally as many people with neuropathy of unknown cause (known as idiopathic neuropathy) as those with diabetes," he states.

"The mantra of doctors used to be neuropathy is progressive and irreversible," says Dr. Dellon. A patient would be given drugs to deal with the problem, he says, adding the drugs had their own side effects and monetary cost. "I was a hand surgeon, and I would treat diabetics with carpal tunnel syndrome. Afterwards, the patient would say - 'My hand feels great. Can you do the same for my feet?' And I would say no that's peripheral neuropathy, and I can't help you. Then one day, I decided, why not see if we can restore sensation and reduce pain in the feet?" That was about 20 years ago, and this physician says he has been successfully treating patients ever since.

Dr. Dellon, who says he has operated on more than 15,000 nerves in the past quarter of a century, has written three books and is in the process of writing his fourth. He has also published more than 340 scientific articles and has written 50 chapters in other author's books.

How the surgery works

Dr. Dellon compares nerve decompression to loosening your belt after a big meal to make room for dessert. "With this surgery, we open tight tunnels in the body that are usually pushing the nerve against the bone. We make a straight cut over where the compressed nerve is and release the tight area through which the nerve passes by dividing a ligament or fibrous band that crosses the nerve. This gives the nerve more room, allows blood to flow better in the nerve and permits it to glide with movements of nearby joints. The surgery takes about two hours and is done as an outpatient procedure," he says. As with any surgery, there are risks. "The biggest risk is the risk of anesthesia," he states. "There will be a scar, and diabetics have to have enough circulation in their feet to promote healing (for the surgery to be successful)." There are also the risks of bleeding and infection. In addition, "if the patient does too much walking too soon, the stitches may tear out."

You must have this type of surgery done soon enough for it to help, Dr. Dellon stresses. "When the surgical decompression is done early in the course of nerve compression, restoration of blood flow to the nerve will stop the numbness and tingling, and permit strength to recover. When the decompression is done later in the course of nerve compression, and nerve fibers have begun to die, decompression of the nerve will permit the diabetic nerve to regenerate. If you wait too long to decompress the nerve, recovery may not be possible," he explains. "If you already have ulcerations on your feet, or have lost toes, then very little sensation may be recovered because the damage to the nerve has become irreversible."

"If you have symptoms, you should have neurosensory testing (which measures the degree of sensory and motor loss). It is non-invasive and not painful," Dr. Dellon relates. "The American Diabetes guidelines say every diabetic should have sensory testing once a year to know if they have neuropathy and are at risk for ulcers and amputations. If your doctor cannot provide the testing, you can have it done here at the Institute." In fact, Dr. Dellon has developed the Pressure-Specified Sensory Device to do such testing. "This is done with a computer and does not hurt because there are no needles and no electric shocks," he says.

As to the effectiveness of peripheral nerve surgery, Dr. Dellon states, "Overall, about 80 percent of those diabetic patients who have had a nerve decompressed have had decreased pain and improved sensory and motor function," he says. Because sensation is restored to the bottom of the feet, balance also is improved. Peripheral nerve surgery can also result in lower health care costs, according to Dr. Dellon. "Patients can take less pain medication. Because they get their balance back, they don't fall and break their hips. They're not admitted to hospitals for infections."