Peripheral Nerves

The peripheral nervous system includes a vast amount of nerves, nerve fiber and nerve endings that grant sensation and movement ability to all organs in our body. Any damage, even the slightest, to one of those nerve or one of its ‘extensions’ would affect the degree of sensation in a certain point in the body – and even whole organs or areas. There are cases where a nerve can restore itself, but in severe damage to a Peripheral nerve, neurosurgery would be required for the nerve’s restoration.

Prof. Shimon Rochkind, one of the leading neurosurgeons in the world for everything relating to the peripheral nervous system, performs at the center for neurosurgical excellence at the Herzliya Medical Center hospital a variety of surgeries for peripheral nerve restoration.

peripheral nerve damage: types and consequences

Usually, peripheral nerve damage will occur due to external factors: cut, stab, gunshot wound, strong pull, or strong and continual external pressure. Such damage can cause partial or complete disconnect in the nerve continuousness – a long and thin fiber carrying electrical signals from the brain to the organ it’s in and return.

The severity of the nerve damage is divided into 5 levels, according to the Sunderland scale:

• Level 1: minor damage that can be fully restored without permanent damage to the nerve tissues
• Level 2: the damage causes some nerve tissue damage but if medical attention is given quickly to the problem causing the damage, restoration can be complete and the damage will be temporary only
• Level 3: The damage is more severe and would in fact cause some permanent damage to the nerve. In this level of damage, restoration could only be partial
• Level 4: The damage to the nerve is severe and causes a scar that would hurt its restoration process. Although the nerve damage isn’t always complete (meaning the nerve isn’t completely severed), only surgery could restore the nerve in this condition
• Level 5: complete damage – complete severance of the nerve fiber, requiring surgery.

The significance of peripheral nerve damage could be critical: severing the nerve continuousness cases the electrical impulses sent from the brain to not reach the destination, and vice versa – the neural message that is a response to external stimulation isn’t fully or completely transmitted to the brain. As a result, many symptoms could appear, among them:

• Acute neuropathic pain (prolonged pain, usually characterized by a “burning” sensation in the damaged nerve)
• Sensation disorders
• Complete loss of sensation
• Motoric disorders (movement disorders)
• Damage to the autonomous nervous system (the system in charge of the body’s involuntary actions, among them the bowels, blood pressure and more).

Treatment of peripheral nerve damage

Treatment of the damage will of course be in accordance with its severity. when the damage is minor (usually levels 1-2), the restoration process will be made by the nervous system itself. Due to the natural features of the peripheral nervous system, the damaged nerve undergoes reinversion (re-growth), leading to an improvement in the functioning and sensation of the damaged area. The restoration process will be “reinforced” and accompanied by physiotherapy and various drug treatment, aiding in catalyzing it and ensuring it is done optimally.

However, there are cases where the natural restoration and various treatments will not improve the condition, or very severe damage that doesn’t allow the body to restore itself. Thus, if there’s no improvement after a certain period or if the damage is complete and the gap between the nerve endings is too big, neurosurgical intervention is required. Prof. Shimon Rochkind is considered one of the leading doctors in the field of peripheral nerve restoration, and throughout the years he performed surgeries to repair such damage with his regular staff countless times. Prof. Shimon Rochkind has even been dealing for years now in research and development of new methods and approaches for optimal restoration of peripheral nerve damage.

The surgery itself involves microsurgical approaches, and deals mainly in the restoration of the damaged nerve – this is because usually, as we noted earlier, the surgical action will be required when the damage is more severe up to complete severance of the damaged nerve fibers.

During the surgery, the nerve will be restored by releasing it from the scars caused to it after the trauma – which would encourage its restoration. Another action that would allow the nerve to restore is transplanting healthy nerves in the damaged area or anastomosis stitching – stitching and connecting the proximal part of the nerve (the part closer to the center of the body) to the distal part (farther from the center of the body), allowing proper neural conduction of the electrical signals in the future.

Sometimes, such neural damage would cause the development of a tumor, neuroma, which would be removed during the surgery. Its removal would also be done with microsurgical tools, in order to maintain the health and integrity of the adjacent nerve tissues and nerve canals.

The center for neurosurgical excellence at the Herzliya Medical Center hospital affords the patient the best medical staff in Israel and the most advanced medical equipment in the world, alongside the highest hospitalization standards, ensuring a very low risk of catching infections – one of the greatest risks in hospitals in Israel.

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