Surgery Strategy Helps Man Walk Again

Justin Brown, M.D., of UCSD Health System recently performed an unconventional surgical procedure that cured full-limb paralysis. The surgery, called a selective peripheral neurotomy, is one of many new procedures that Dr. Brown has begun using.

For the selective peripheral neurotomy, Brown operates exclusively on damaged nerves. In a typical leg procedure, Brown begins with an incision behind the knee, exposing the tibial nerve. He then trims back specific, problematic nerve branches up to 80 percent. Cutting the nerve reduces undesirable motor information from being relayed back to the spinal cord, which causes spasticity. Brown said this procedure eliminates the need to cut or elongate the tendon itself. Rehabilitation can begin 72 hours after the procedure is completed.

“Selective peripheral neurotomy may be appropriate for patients with brain and spinal cord injury from strokes or tumors, cerebral palsy or multiple sclerosis,” Brown said.

After a head-on car collision, Rick Constantine, 58, was told he would never walk again. Four years of confinement to a wheelchair later, Constantine decided to undergo an unconventional surgical procedure performed by Brown. The procedure took approximately three hours, and a week later, it restored the use of Constantine’s leg.

Selective peripheral neurotomy is not the only new procedure envisioned by Brown and UCSD Health System. Another surgical procedure created by Brown, called distal nerve transfers, involves taking nerves from locations far away from a particular area and relocating them to restore functions in an area that has been severely damaged. Specifically, motor nerves are utilized to re-innervate, or restore, movement and sensory nerves are used to restore sensation.

The potential of distal nerve transfers is seen upon examining the treatment options of a patient with tetraplegia, or the paralysis of all four limbs and the torso. Specifically, distal nerve transfers can be used to restore motor functions in the upper limbs, allowing a patient with tetraplegia greater independence of movement. Nerve transfers also generally offer greater functional exchange than the more common practice of tendon transfers.

For nerve transfers, sacrificing one simple function can potentially restore multiple, complex functions. For instance, a single nerve from the wrist muscle, when transferred to a nerve for movement in multiple fingers, can often restore independent movement in each of the fingers. Benefits of this surgery, and similar procedures, are evident for military veterans, stroke patients, spinal cord injuries and beyond.

Recently, Constantine walked a mile with the assistance of a cane. “Dr. Brown’s surgery works,” Constantine said. “I’m living proof of it. Don’t give up.”

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