Neurolysis: Difference between revisions
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== Description<br> == | == Description<br> == | ||
Neurolysis is a the breaking down or freeing up of [[Neurodynamics|nerve]] tissues via | Neurolysis is a the breaking down or freeing up of [[Neurodynamics|nerve]] tissues via radiofrequency (heat), chemoneurolysis (chemical), or cyroablation techniques. This can be a permanent or temporary change. These techniques cause [[Wallerian Degeneration|Wallerian degeneration]] of the nerve axon distal to the lesion. The nerve degeneration interferes with the the transmission of nerve signals. eg nerve fibers carrying nociceptive signals are interrupted resulting in pain relief.<ref name=":4">Tariq RA, Mueller M, Green MS. Neuraxial Neurolysis. [Updated 2022 Sep 26]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK537157/</ref> | ||
External neurolysis is releasing [[Scar Management|scar]] tissue from the nerve | Note: | ||
* External neurolysis is releasing [[Scar Management|scar]] tissue from the nerve | |||
* Internal neurolysis is releasing the compressed tissue.<ref name=":0">León-Andrino A, Noriega DC, Lapuente JP, Pérez-Valdecantos D, Caballero-García A, Herrero AJ, Córdova A. [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9144828 Biological Approach in the Treatment of External Popliteal Sciatic Nerve (Epsn) Neurological Injury: Review.] J Clin Med. 2022 May 16;11(10):2804. / </ref> | |||
== Indications == | == Indications == | ||
[[ | Patients need to carefully selected. Evidence suggests that it is best used for pain that is primarily somatic in origin. Visceral or neuropathic pain treatment is less valid.<ref name=":4" /> | ||
Neuraxial neurolysis can be helpful in intractable cancer-related pain unresponsive to pharmacological analgesic therapy eg [[opioids]] and antitumor therapy.<ref name=":5">Veihelmann A. Spinal injections, [https://pubmed.ncbi.nlm.nih.gov/30481838/ Epidural neurolysis and denervation for specific low back pain and sciatica.] Zeitschrift für Orthopädie und Unfallchirurgie. 2019 Aug;157(04):417-25.Available:https://pubmed.ncbi.nlm.nih.gov/30481838/ (accessed 5.10.2023)</ref> | |||
Neurolysis can be used for egs: | |||
* [[Sciatica]]<ref>Veihelmann A. [https://pubmed.ncbi.nlm.nih.gov/30481838/ Spinal Injections, Epidural Neurolysis and Denervation for Specific Low Back Pain and Sciatica.] Z Orthop Unfall. 2019 Aug;157(4):417-425. English, German. </ref> | * Low back pain and [[Sciatica]]<ref>Veihelmann A. [https://pubmed.ncbi.nlm.nih.gov/30481838/ Spinal Injections, Epidural Neurolysis and Denervation for Specific Low Back Pain and Sciatica.] Z Orthop Unfall. 2019 Aug;157(4):417-425. English, German. </ref> results from research for epidural neurolysis for sciatica have been promising, as have radiofrequency neurolysis of the medial branch of the dorsal root for the treatment of axial facet-related back pain.<ref name=":5" /> | ||
* [[Brachial Plexus Injury|Brachial plexus injuries]]<ref name=":1">Rich JA, Newell A, Williams T. [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6936391/ Traumatic brachial plexus injury rehabilitation using neuromuscular electrical muscle stimulation in a polytrauma patient.] BMJ Case Rep. 2019 Dec 23;12(12):e232107. </ref> | * [[Brachial Plexus Injury|Brachial plexus injuries]]<ref name=":1">Rich JA, Newell A, Williams T. [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6936391/ Traumatic brachial plexus injury rehabilitation using neuromuscular electrical muscle stimulation in a polytrauma patient.] BMJ Case Rep. 2019 Dec 23;12(12):e232107. </ref> | ||
* [[Quadrilateral Space Syndrome|Quadrilateral space syndrome]]<ref>Zurkiya O. [https://pubmed.ncbi.nlm.nih.gov/34815962/ Quadrilateral space syndrome.] Cardiovasc Diagn Ther. 2021 Oct;11(5):1112-1117. </ref> | * [[Quadrilateral Space Syndrome|Quadrilateral space syndrome]]<ref>Zurkiya O. [https://pubmed.ncbi.nlm.nih.gov/34815962/ Quadrilateral space syndrome.] Cardiovasc Diagn Ther. 2021 Oct;11(5):1112-1117. </ref> | ||
* [[Foot drop|Peroneal nerve palsy (foot drop)]]. <ref name=":2">Chow AL, Levidy MF, Luthringer M, Vasoya D, Ignatiuk A. [https://pubmed.ncbi.nlm.nih.gov/34397520/ Clinical Outcomes After Neurolysis for the Treatment of Peroneal Nerve Palsy: A Systematic Review and Meta-Analysis.] Ann Plast Surg. 2021 Sep 1;87(3):316-323. </ref>Peroneal is the third most common neuropathy after [[Median Nerve|median]] and [[Ulnar Nerve|ulnar]].<ref name=":0" / | * [[Foot drop|Peroneal nerve palsy (foot drop)]]. <ref name=":2">Chow AL, Levidy MF, Luthringer M, Vasoya D, Ignatiuk A. [https://pubmed.ncbi.nlm.nih.gov/34397520/ Clinical Outcomes After Neurolysis for the Treatment of Peroneal Nerve Palsy: A Systematic Review and Meta-Analysis.] Ann Plast Surg. 2021 Sep 1;87(3):316-323. </ref>Peroneal is the third most common neuropathy after [[Median Nerve|median]] and [[Ulnar Nerve|ulnar]].<ref name=":0" /><br> | ||
== Post-Op Management == | == Post-Op Management == | ||
Revision as of 06:11, 5 October 2023
Original Editor - Chloe Waller
Top Contributors - Chloe Waller, Lucinda hampton and Carina Therese Magtibay
Description
[edit | edit source]
Neurolysis is a the breaking down or freeing up of nerve tissues via radiofrequency (heat), chemoneurolysis (chemical), or cyroablation techniques. This can be a permanent or temporary change. These techniques cause Wallerian degeneration of the nerve axon distal to the lesion. The nerve degeneration interferes with the the transmission of nerve signals. eg nerve fibers carrying nociceptive signals are interrupted resulting in pain relief.[1]
Note:
- External neurolysis is releasing scar tissue from the nerve
- Internal neurolysis is releasing the compressed tissue.[2]
Indications[edit | edit source]
Patients need to carefully selected. Evidence suggests that it is best used for pain that is primarily somatic in origin. Visceral or neuropathic pain treatment is less valid.[1]
Neuraxial neurolysis can be helpful in intractable cancer-related pain unresponsive to pharmacological analgesic therapy eg opioids and antitumor therapy.[3]
Neurolysis can be used for egs:
- Low back pain and Sciatica[4] results from research for epidural neurolysis for sciatica have been promising, as have radiofrequency neurolysis of the medial branch of the dorsal root for the treatment of axial facet-related back pain.[3]
- Brachial plexus injuries[5]
- Quadrilateral space syndrome[6]
- Peroneal nerve palsy (foot drop). [7]Peroneal is the third most common neuropathy after median and ulnar.[2]
Post-Op Management[edit | edit source]
Early management[edit | edit source]
- Pain control
- Oedema management
- Immobilisation may be advised by the surgeon. [8] There is no general consensus in the research if the limb should be immobilised or not, and if so, the duration of immobilisation. [9]
Rehabilitation[edit | edit source]
Promoting nerve regeneration requires a varied treatment plan, aiming for sensory and motor cortical remapping. This can include:
- Strengthening exercises
- Manual therapy
- Hydrotherapy[8]
- Neuromuscular electrical stimulation[5]
- Combined neurocognitive training[10]
Complications[edit | edit source]
Risk of complications is low but includes postoperative infection, wound dehiscence, hematoma, bleeding, relapse of the neuropathy or sepsis. [7]
References[edit | edit source]
- ↑ 1.0 1.1 Tariq RA, Mueller M, Green MS. Neuraxial Neurolysis. [Updated 2022 Sep 26]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK537157/
- ↑ 2.0 2.1 León-Andrino A, Noriega DC, Lapuente JP, Pérez-Valdecantos D, Caballero-García A, Herrero AJ, Córdova A. Biological Approach in the Treatment of External Popliteal Sciatic Nerve (Epsn) Neurological Injury: Review. J Clin Med. 2022 May 16;11(10):2804. /
- ↑ 3.0 3.1 Veihelmann A. Spinal injections, Epidural neurolysis and denervation for specific low back pain and sciatica. Zeitschrift für Orthopädie und Unfallchirurgie. 2019 Aug;157(04):417-25.Available:https://pubmed.ncbi.nlm.nih.gov/30481838/ (accessed 5.10.2023)
- ↑ Veihelmann A. Spinal Injections, Epidural Neurolysis and Denervation for Specific Low Back Pain and Sciatica. Z Orthop Unfall. 2019 Aug;157(4):417-425. English, German.
- ↑ 5.0 5.1 Rich JA, Newell A, Williams T. Traumatic brachial plexus injury rehabilitation using neuromuscular electrical muscle stimulation in a polytrauma patient. BMJ Case Rep. 2019 Dec 23;12(12):e232107.
- ↑ Zurkiya O. Quadrilateral space syndrome. Cardiovasc Diagn Ther. 2021 Oct;11(5):1112-1117.
- ↑ 7.0 7.1 Chow AL, Levidy MF, Luthringer M, Vasoya D, Ignatiuk A. Clinical Outcomes After Neurolysis for the Treatment of Peroneal Nerve Palsy: A Systematic Review and Meta-Analysis. Ann Plast Surg. 2021 Sep 1;87(3):316-323.
- ↑ 8.0 8.1 Novak CB, von der Heyde RL. Rehabilitation of the upper extremity following nerve and tendon reconstruction: when and how. Semin Plast Surg. 2015 Feb;29(1):73-80.
- ↑ de Santana Chagas AC, Wanderley D, de Oliveira Ferro JK, Alves de Moraes A, Morais de Souza FH, da Silva Tenório A, Araújo de Oliveira D. Physical therapeutic treatment for traumatic brachial plexus injury in adults: A scoping review. PM R. 2022 Jan;14(1):120-150.
- ↑ Gohritz A, Laengle G, Boesendorfer A, Gesslbauer B, Gstoettner C, Politikou O, Sturma A, Aszmann OC. Nerve Transfers for Brachial Plexus Reconstruction in Patients over 60 Years. J Pers Med. 2023 Apr 12;13(4):659.
