Neurolysis: Indication, risks, recovery period

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Article reviewed and approved by Dr. Ibtissama Boukas, physician specializing in family medicine

Un nerf is a set of nerve fibers which, in their normal state, are capable of transmit information sensory and motor functions from the body to the brain and/or from the brain to the organs of the body.

In pathological cases, such as nerve compression, the latter is no longer able to transmit the stimuli. This can cause motor and sensory disorders that the doctor can diagnose. To treat the compression, your doctor may opt for a medicinal solution, or even surgery. Neurolysis is just one example of a possible operation.

What is neurolysis ? What are his indications and contraindications? How long does the recovery period of such intervention? The point in this article.

What is neurolysis?

La neurolysis is a surgical procedure which consists of the destruction, dissection and exploration of a nerve cell or a damaged nerve. The objective is to release restrictions or local adhesions at the tissue level. In simple terms, it is a surgical act which aims to release a nerve from a specific point.

It should be known that there are certain nerves more predisposed to being compressed: the people affected will then be better candidates for neurolysis. One can quote for example the rigid anatomical canals like the bones, the ligaments or the fibrous arcades (one speaks in this case of a canal syndrome).

La neurolysis technique performed varies depending on the area of ​​compression and the lesion. Generally, it is used as a last resort when the drug solution fails. Only the surgeon is able to assess the need for it to be performed.

Depending on its therapeutic indication, neurolysis can also consist of permanent nerve destruction by injection of a chemical product such as alcohol, then carried out by a radiologist or a surgeon.

This will insert a needle or a thermal probe into the affected area so that it is in contact with the plexus (groups of nerves), or the nerve in question. The healthcare professional who performs this procedure is guided by imagery, which reduces the risk of complications. Indeed, this will avoid touching the nerves which are in depth, and will precisely target the injured or compressed nerve.

To summarize, the principle of neurolysis is simple: it consists in eliminating the cause of nerve compression. The techniques are very diverse because the compression sites can also be varied.

Indications for Neurolysis

Neurolysis can have several indications, but the main one is nerve compression. Indeed, a compressed nerve generates sometimes a series of severe symptoms, as in compression of the spinal cord resulting in quadriplegia or paraplegia. Neurolysis may also be used in less severe cases of nerve compression from the following group of injuries: 

  • mechanical injuries,
  • thermal injuries,
  • Acute compression syndromes 
  • Chronic pain that does not respond to treatment
  • Pain management in cancer patients

This operation is performed for treat many nerve injuries different devices, with generally excellent results. For example, appropriate surgical management of radial, ulnar, and median nerve injuries has been associated with excellent functional recovery.

However, the prognosis is guarded when neurolysis is used to treat injuries where neural continuity is lost. We speak, for example, of the cases of lacerations, the injuries associated with fractures or again and the gunshot wounds.

Types of neurolysis

There are three types of neurolysis:

  • External neurolysis : also called exoneurolysis or truncal neurolysis, it consists of the surgical elimination of adhesions around the nervous tissue;
  • Internal neurolysis (also called endoneurolysis or neurolysis fasciculai): it consists of the individual dissection of the nerve fibers of a compressed nerve;
  • Neurosurgical neurolysis: it generally aims to fight against pain;

What are the risks and contraindications of neurolysis?

Like any surgical procedure and although they are rare, there are certain risks of complications and side effects related to neurolysis. Vhere are the main ones:

  • Hematoma: common to several interventions, the hematoma can also occur in case of neurolysis. It usually resolves spontaneously, and in rare cases requires surgical drainage.
  • Algodystrophy: it consists of a painful and inflammatory episode which generally requires several months of treatment and follow-up. Treated medically, its occurrence, recovery and the complications that may result are often random. Unfortunately, its exact cause remains unknown. Algodystrophy requires pain management and appropriate rehabilitation.
  • Infection: it is rarer than hematoma and algodystrophy. It consists of a deep infection that generally requires surgery and a period of convalescence with antibiotic therapy.
  • Nerve damage: Decreased sensitivity or transient hypersensitivity may be a complication of neurolysis.
  • Scar: much rarer, the scar after neurolysis can remain swollen and painful. It is associated with stiffness which may require an extension of the rehabilitation period. For a long time, the strength of the surrounding muscles may decrease.

There are other complications and risks associated with neurolysis that vary depending on the degree of nerve damage and the area affected. However, it should be noted that the techniques of neurolysis are improving day by day, and the risks associated with this intervention are increasingly limited.

Indeed, the surgeon is guided by imaging in order to target the area of ​​the nerve concerned to the nearest millimeter to precisely avoid the risk of complications.

How long does recovery take?

Generally, 6 weeks after surgery, patients can resume more or less complete activity. Indeed, the numbness relief, tingling and pain is often immediate to neurolysis.

However, it all depends on the severity of the nerve injury or compression. In the cases the more serious, it requires a long recovery period. Thus, the relief of numbness and the disappearance of pain can gradually spread over several months.

In addition, it is worth pointing out that smoking not only increases the recovery period, but also the risk of complications. It is therefore advisable to stop smoking 2 months before the operation, and not to start smoking again during the convalescence period.

Conclusion

In summary, neurolysis consists of a surgical technique which aims to eliminate the cause of compression of a nerve which may be traumatic or pathological. It is generally indicated to fight against pain. Like any surgical procedure, there is a risk of hematoma, infection or poor healing, although current neurolysis techniques avoid any risk of complications.

Recovery time after neurolysis essentially depends on the severity of the nerve injury or compression, as well as the location of the injured nerve. However, as a rule, one can feel an improvement immediately after the procedure. The patient regains normal activity, on average, 6 weeks after the operation. It is useful to underline that only the surgeon is able to give you the green light for a resumption of a normal life after the surgical act.

Good recovery !

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