Selective neurectomy refers to the cutting of a portion of a peripheral nerve in a “selective” or directed fashion. In another words, some selection process is used to guide the surgeon in what portion of the nerve is cut and, therefore, what portion of the nerve is preserved. The selective neurectomy employed by specialists at Function involves exposing the nerve at a point where it is giving off branches to a muscle whose tightness is contributing to a disability, stimulating each of the nerve’s branches to that muscle and then cutting roughly 70% of the branches that are causing the greatest degree of contraction in the muscle. This technique has several advantages. By exposing the branches going to the targeted muscle and only working with them the portion of the nerve containing fibers that deliver skin sensation back to the brain are preserved. By stimulating each branch an appreciation of which branches cause the greatest force of contraction in the muscle becomes known with cutting becoming focused on them. Lastly, by stimulating each branch there is a greater likelihood that some functioning nerve supply will be maintained to the muscle, decreasing the chance that there will be complete paralysis.
The selective neurectomy can be performed on any nerve giving branches to a muscle whose stiffness or spasticity is causing functional problems and or pain. Commonly at Function a reversible injection is given to the problematic muscle that temporarily decreases its nerve supply to assess the possible impact of a neurectomy. The solution used for these injections is usually BOTOX or botulinum toxin. The effect, which usually has an onset within days of injection and lasts several months, is then evaluated to insure that the desired effect is achieved by relaxing the muscle. When this is confirmed, the selective neurectomy can be used to make the benefit permanent.
Examples of nerves that surgery has been performed upon at Function
Function is one of the few centers in North America that offers this procedure for the treatment of muscle spasticity or stiffness.