Thursday, December 11, 2014

Surgical denervation for joint arthritis in spinal cord injured patients – small incisions for great pain relief

Patients with para- or tetraplegia frequently suffer from painful arthrosis, especially in their upper extremity due to heavy load during wheel-chair driving and transfers. However, frequently used bony procedures, such as fusions (arthrodesis), arthroplasty or joint implants have great disadvantages for this population, as they require long post-operative immobilization or severely restrict joint mobility which is a prerequisite for using manual wheel-chairs.
Surgical denervation means selective transection of nerve fibers transmitting pain from the joint to the brain which leads to significant reduction of pain symptoms. Joint integrity, skin sensitivity and motor innervation remains unaffected. No implants, postoperative rehabilitation or immobilization is required and early functional training is possible. All more invasive procedures, if needed in future, remain feasible.
This technique requires thorough anatomical knowledge and meticulous surgical technique. Since its introduction in the 1960ies, initial success rates of 80% or more have been reported for wrist but also in other joints, such as the shoulder, elbow, hand (finger and thumb) or the lower extremity (knee and ankle) have been successfully treated with this technique.
The effect of the operation can be predicted pre-operatively by temporarily blocking the nerves responsible for the respective joint by local anaesthesia.

In patients with spinal cord injuries, the method has been introduced recently at the Swiss Paraplegia Center in Nottwil by Dr. Andreas Gohritz. The incisions are small as depicted in the schematic picture, but great relief is possible, above all in painful wrists and thumb carpo-metacarpal (basis of the thumb) joints.