Surgery, even under the best of conditions, carries some element of risk. Despite every precaution, there could be an unforeseen development or human error. That’s certainly the case with spinal surgery, where the operation is occurring very close to the spinal cord. The last thing any doctor or patient wants is for the patient to leave with more nerve damage than he or she had before.
But it does happen. Sometimes, due to accidents, a nerve can be cut or crushed during surgery. Let’s look at how surgical crushing of a nerve might happen, how it could affect the patient, and what can be done to repair the damage afterward.
How Nerves Send Signals
The nervous system is split into two parts: the central nervous system (CNS), which includes the brain and spinal cord; and the peripheral nervous system (PNS), which are the many nerves that branch out from the spinal cord and carry signals from the CNS to the limbs and organs. It’s a vast, important, near-instantaneous electrical network that regulates everything from walking to digestion to the heartbeat.
The peripheral nerves are comparatively unprotected, so a severe blow, impact, or deep laceration can damage them. When that happens, the signal coming from the CNS is impaired or even completely blocked. That results in pain, tingling, or numbness in the affected area.
Some injuries to the nerves are relatively minor and recover fully in time. For instance, neurapraxia (the failure of peripheral nerves to conduct signals) can often be treated with rest, ice/heat therapy, and possibly some anti-inflammatory medications.
In the case of other, more serious nerve injuries, there’s damage to either the axons (nerve fibers) or myelin sheath (a fatty, conductive substance that surrounds the fibers), part of the nerve is cut or even severed. Surgery may be necessary to reconnect the damaged nerve endings and restore at least partial function to the affected muscles or limb.
Risks in Spinal Surgery
As mentioned above, any type of spinal surgery comes with some risks. With traditional open spine surgery, the surgeon makes a large incision and detaches some of the muscles around the spine in order to get better access. This procedure involves the cutting and tearing of muscles and ligaments, and so there’s a chance that one of many nerves packed into the spinal area could be accidentally cut or compressed.
As a result, a surgery that was intended to relieve painful symptoms of nerve injury ends up causing more damage. This surgical crushing of a nerve is called neurotripsy.
If a nerve near the spine is compressed during surgery, some of these symptoms could manifest and last for quite a while after the surgery:
- Pain, including neuropathic pain – an extreme burning or stabbing sensation that doesn’t fade away
- Tingling or numbness (“pins and needles”) in the neck, shoulders, arms, hands, lower back, hips, legs, and feet
- Weakness in one or more limbs
- Difficulty walking
In more extreme cases, the disruption of signals to major organs, such as the heart, lungs, or stomach, which can lead to serious health complications
Although uncommon, nerves can also be damaged if the tissues around them become inflamed during surgery. In rare cases, post-surgical pain has been linked to anesthesia, although anesthesiologists and surgeons are still puzzled by the cause. One possible reason is the positioning of the patient during a long surgery, where a nerve on a limb may be inadvertently compressed or crushed during the operation.
Treating Post-Operative Pain
If you experience increased pain after spine surgery, you should talk to your surgeon to figure out whether or not you suffered additional nerve damage. Depending on the cause and severing of the injury, medications may be able to deal with the symptoms while the nerve regenerates:
- Anti-inflammatory drugs for mild to moderate pain
- Opioids for more intense pain
- Anticonvulsants to help with nausea that often accompanies chronic neuropathic pain
- Nerve blocks or epidurals for severe pain
Physical therapy, massages, and acupuncture are other options. If, after a few weeks or months, you feel no improvement, then another surgery may be required.
Fortunately, the vast majority of spine surgeries go as planned, although many patients do still report chronic post-operative pain. As surgical techniques and knowledge improve, we continue to move further away from traditional open spine surgery toward less invasive procedures that require only minor incisions.
By reducing the risk of the surgical crushing of a nerve, surgeons will improve the chance that spinal surgeries will do exactly as intended: restore a better quality of life for their patients.