For some patients with peripheral nerve damage and extremity or spine weakness, nerve transfer surgery can be life-changing for improving or restoring function and reducing pain. In this Q&A, Brandon W. Smith, MD, a Duke neurosurgeon and spine surgeon specializing in peripheral nerve surgery, discusses his new nerve regeneration practice at Duke and how the field of peripheral nerve reconstruction has evolved rapidly over the past few years.
Q: What is nerve transfer surgery?
Smith: When patients have a weakness from a trauma, tumor, or another disease, the affected nerves can sometimes be rewired with a nerve transfer. This procedure involves taking nerves from muscles that still work and giving them to more important ones based on the individual patient’s needs. In the past, if a nerve was injured, you would cut the bad part out and sewed it back together to see if it would work. Now, with nerve transfer surgery, we’re starting to see that there are more creative ways to help people reach their functional goals, and we have better data to support that many nerve injuries can be fixed because of this type of procedure.
Q: How does this surgical approach benefit patients?
Smith: Even small gains can mean a lot for a patient with peripheral nerve damage, so I think it's worth it for any patient with focal weakness to be evaluated. When preparing for each nerve transfer surgery, I have to think really carefully about each specific patient’s needs and what they're willing to trade. For example, if a patient doesn’t want to take from a nerve that goes to the pointer finger and the thumb because they like to sew, I could take the one that goes to the pinky instead.
Q: What is unique about your background and reconstructive nerve surgical practice at Duke?
Smith: I am fellowship trained in both peripheral nerve and brachial plexus surgery as well as spine surgery, so I can assess patients with either of these pathologies. As a peripheral nerve surgeon, I operate on nerves from head to toe. I also work with both adults and children from a nerve standpoint, and will manage the entire range of peripheral nerve surgery. My range of specialties includes adult and neonatal brachial plexus surgery, nerve transfer surgery, nerve pain, denervation surgery for cervical dystonia, peripheral nerve tumors and masses, and nerve-related extremity weakness.
The earlier a patient is referred to Duke, the better their potential outcomes can be. Our team’s multidisciplinary approach to patient care combines expertise in neurology, neurosurgery, orthopaedics, and plastic surgery to evaluate and treat patients, so we are prepared to help patients with any type of nerve problem.
Q: What recent advances have there been in the field of peripheral nerve surgery?
Smith: Since I first started in this field, the list of conditions for which we would consider nerve transfer surgery has grown rapidly. For example, even a few years ago, we would never operate on a spinal cord injury, but now we do. Peripheral nerve surgery is also starting to gain traction among patients who have had a stroke and are now experiencing painful, debilitating spasticity in part of their extremities. To resolve those symptoms, we can sometimes transfer a nerve from the opposite side of the body. Finally, nerve transfers are now used to help patients with C5 palsy or weakness after spine surgery, which causes a loss in their ability to move their shoulder. While almost all patients get better, nerve transfer surgery is an option for those whose symptoms don’t improve.