Center for Paralysis and Reconstructive Nerve Surgery
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David became a quadriplegic after a construction accident almost two years ago. In February 2011, he underwent surgery that implanted a diaphragm pacemaker, which eventually will allow him to breathe on his own. He sought medical care at the Center for Treatment of Paralysis and Reconstructive Surgery at Jersey Shore University Medical Center where Dr. Matthew Kaufman performed a rare surgery to help David.
Advanced Reconstructive Surgery Options
The following are just a few of the advanced reconstructive surgery techniques we offer:
Brachial Plexus Reconstruction
Traumatic injuries such as car accidents, motorcycle accidents, and boating accidents can often lead to nerve injuries to the brachial plexus. The brachial plexus is the network of nerves in the armpit that control all the functions of the arm and hand. The reconstructive surgery required to correct these injuries is complex and time-consuming, and it requires an incredible understanding of the anatomy and physiology of this complicated area of the body.
Our doctors are experts in this advanced reconstructive surgery technique. In addition to standard brachial plexus reconstruction, we have performed 9 nerve transplants for massive brachial plexus injuries that could not be reconstructed with standard techniques.
Only eleven nerve transplants have been performed in the world, and nine of those were done right here in New Jersey by our physicians. With this advanced reconstructive surgery technique, our surgeons are able to restore function to people who have lost the use of several nerve trunks in the arm or leg nerve plexuses. We draw upon a local team of experts in neurology, immunology, transplant medicine, and infectious diseases to make this complex reconstructive surgery procedure proceed smoothly and assure the best possible outcomes.
Nerve Reconstruction for Phrenic Nerve Injury
Phrenic nerve injury leads to diaphragm paralysis, the loss of function to the primary muscle involved in breathing. The consequences include shortness of breath with exertion, and difficulty breathing in certain positions while sleeping. The most common causes of phrenic nerve injury are surgical complications and trauma. There has been little hope for individuals suffering with this condition until recently.
Phrenic nerve surgery was developed in 2007 as a method to reverse diaphragm paralysis and restore more normal breathing function. The surgery involves a combination of nerve decompression and nerve grafting to “bypass” the site of injury. These methods were developed decades ago to reverse nerve damage in other parts of the body. Applying these techniques for treatment of diaphragm paralysis has been overwhelmingly successful in the treatment of over 150 patients with this condition.
Following phrenic nerve surgery, the vast majority of patients experience some degree of recovery, allowing them to resume activities that require effort and exertion, and improving sleep efficiency.
Diaphragm Pacemaker for Ventilator Dependency
After cervical spinal cord injury many patients require a ventilator to help them breathe. There are serious consequences of ventilator dependency, including risks of life threatening infection and even death. In addition, there are significant quality-of-life issues related to being confined to a ventilator. We are one of only a few centers in the country that performs the procedure to implant a diaphragm pacemaker. A diaphragm pacemaker allows select patients with spinal cord injury to breathe independently, without the need for long term ventilator support. Our doctors have pioneered minimally invasive approaches for implantation of a diaphragm pacemaker, and have developed ground-breaking nerve reconstruction procedures to help patients who would otherwise not be candidates for the diaphragm pacemaker.
Nerve Decompression Reconstructive Surgery for Peripheral Neuropathy
Peripheral neuropathy is a common and difficult medical problem that traditionally is thought to have few treatment options. Unfortunately, it is a leading cause of amputations in our country. People with peripheral neuropathy have decreased sensation in the extremities and are, therefore, prone to wounds that become infected and then require amputation. For many patients, there is severe, debilitating pain also associated with this condition. Peripheral neuropathy has many causes, the most common of which is diabetes. The symptoms of neuropathy include pain, numbness, tingling, and loss of strength in the affected arm or leg. In severe cases, it can lead to amputation of the toe, foot, or even the leg. In many cases, the symptoms are due to the diseased nerves being compressed, or “pinched,” at known, predictable points along the leg or arm.
Our doctors are pioneers among their peers in treating neuropathy with reconstructive surgery. This procedure consists of decompressing the “pinched” nerves in the leg or arm. The incisions are very small, pain is minimal, and the procedure is done as an outpatient in most cases.
Results of this reconstructive surgery are usually dramatic and patients often experience relief in the recovery room! While pain relief is an important goal of this reconstructive surgery, reducing the risk of wounds that lead to amputation is most critical. By improving sensation in the feet and hands, a patient is far less likely to sustain non-healing wounds. In fact, few, if any, patients treated with this technique ever develop a wound or need an amputation. Thus, the procedure protects the patient from future problems from their neuropathy.
Recurrent pressure sores in individuals with spinal cord injury become very difficult to treat unless sensation can be returned to areas where the pressure sores are located. In the past the idea of recovering sensation in paralyzed individuals was believed impossible.
Our doctors are performing a groundbreaking procedure intended to restore sensation to the hip and buttock areas in paraplegics with recurrent pressure sores. Nerve grafting is performed in conjunction with flap surgery to treat the pressure sore and provide the opportunity for sensory recovery.
Spinal cord injury often results in paralysis and loss of sensation to portions of the body. Individuals may lose sensation to the lower body and are therefore unable to detect when there is excessive pressure in these locations while sitting in a wheelchair or lying in bed. Over time, this problem progresses from skin breakdown to open wounds, and even to life threatening infections of the underlying bone.
Surgical treatment is sometimes necessary to clean and cover the wounds. Reconstruction of these wounds is often performed using flap surgery – healthy skin and muscle from nearby locations is mobilized to cover the areas where pressure sores are located.
Nerve Reconstruction Treatment for Swallowing Disorders
After a stroke many patients find it difficult to eat normally due to swallowing problems. The process of swallowing is rather complex, requiring the precise coordination of various muscles triggered by sensory feedback.
A stroke may cause an imbalance in this process and can lead to aspiration – the leakage of food and/or saliva into the breathing passages. If left untreated aspiration will often lead to life threatening conditions such as pneumonia. Individuals suffering from stroke and aspiration often have little hope and may be reliant on a feeding tube for nutrition. Until now there have been few options for reversing swallowing difficulties associated with stroke.
We offer an innovative surgical procedure to select stroke patients. The goal of the procedure is to restore sensation to the upper airway so that stroke patients may protect their airway during swallowing and reduce or eliminate aspiration. Ultimately, the patient would then be able to return to an oral diet rather than a feeding tube for nutritional requirements, thereby improving function and quality of life following stroke.
Orbital Decompression for Graves’ Ophthalmopathy
Grave’s disease is an autoimmune, multi-system disorder that affects nearly 14 in 100,000 people. It is known to cause, among other diseases, swelling of the thyroid (goiter), increased heart rate (tachycardia), and painful lesions of the skin. Ophthalmopathy is clinically relevant in 50% of Grave’s cases; making it the most common non-thyroidal manifestation of the disease. This eye condition is caused by an abnormal increase of fat tissue within the orbital cavity, as well as over development of the eye muscles. This results in bulging eyes, headaches, pressure sensation, and tearing. In extreme cases, the intra-orbital pressure can cause optic neuropathy leading to a loss of vision. Patients of this disorder can also suffer the psychological effects of disfigurement. We offer surgical treatment to reverse the effects of this disorder, and improve the quality of life for our patients.
Patients presenting with Grave’s Ophthalmopathy will undergo a thorough clinical evaluation, including CT, MRI, and ultrasound scans to confirm diagnosis. At its early active stage, the disease can be treated with nonsurgical therapies, such as corticosteroids. This form of treatment has been met with a 65% response rate. In its more advanced stages, decompression surgery becomes necessary to reverse the effects of this condition. The procedure involves removing excess fat from the orbital cavity, as well as expanding the orbital wall to alleviate pressure and congestion in and around the eyes. This will correct issues such as orbital congestion, pain, eye bulging, and eye lid disfigurement; in extreme cases optic nerve damage, corneal breach, and eye dislocation are prevented.
Treatment for Pudendal Nerve Entrapment
Pudendal neuralgia (PN) is intense pain in the area in and around the pudendal nerve, which is located in the pelvic region and carries sensory and motor fibers. The pudendal nerve stems from the sacrum and runs through the pelvic area into the urethra, anus, rectum, perineum and genitalia. PN is caused by the entrapment, compression or dysfunction of the pudendal nerve. This uncommon condition is the source of chronic pelvic pain.
Pudendal nerve decompression surgery is an option that is usually considered after more conservative therapies fail. These therapies include such measures as lifestyle changes, pelvic floor physical therapy, medications and nerve blocks. Our surgeons enter the pelvis through the skin in the area of the buttocks to decompress the pudendal and other associated nerve structures in an effort to alleviate the symptoms. This technique is often highly effective, with many patients either symptom-free or with a significant relief of symptoms following treatment.
Chronic joint pain is an increasingly present condition in our society. Whether from degenerative changes, trauma such as accidents, or structural abnormalities, there is a population that experiences persistent joint pain. While orthopedic or other surgical or even non-surgical techniques may result in the relief of joint pain, there is a minority of patients who despite all possible traditional treatments cannot find relief.
To understand how joint works denervation, it is helpful to understand the structure and function of nerves. Like other parts of the body, sensory nerves run throughout the joints, providing sensation (in this case, chronic pain) to the joint’s surrounding structure. That joint pain may be caused by injury or damage to that nerve. Joint denervation surgery removes a segment of the damaged nerve in order to eliminate or disrupt the chronic pain signal to the brain.
With the relief of pain, normal function can be restored to the joint. As a result, the surrounding muscles, tendons and other structures work more effectively, increasing the range of motion and general functionality.