Mapping Out Peroneal Nerve Branches
By Admin | May 01, 2023
As we get older, the mobility that we once took for granted becomes more and more jeopardized. For all the time people spend working in front of a computer screen or sitting in front of the TV when they’re younger, a good portion of them will inevitably look back with some degree of regret when walking is no longer easy. They’ll eventually turn to solutions like physical therapy and surgery to try and revive those privileges that were once squandered. And when that time comes, we’ll want the surgeon to know with confidence that when we wake up we’ll leave better than when we came in.
The peroneal nerve is small and crosses around the knee. At full capacity, it supplies movement and sensation to the lower leg, foot and toes. Compression to that same peroneal nerve introduces complications to those functions - making mobility challenging.
A 69 year old female presented with right peroneal neuropathy and right lower leg atrophy. After completing physical therapy, she noticed pronounced aching in her leg and her gait became abnormal resulting in a limp known as “foot drop” and lost feeling in her lower right leg.
After consulting with her doctor, a right peroneal nerve exploration and decompression was planned. The surgeon hoped that after assessing the condition of the nerve, pressure relief would alleviate the patient’s limp and foot drop. While the procedure can be performed successfully, the postoperative outcome can’t be guaranteed.
By introducing intraoperative neuromonitoring into the procedure, surgeons can access more information about the patient’s condition, make better decisions, and provide better outcomes. In the case of our patient, the following neuromonitoring interventions were used: somatosensory evoked potentials, motor evoked potentials, and electromyography with nerve conduction studies being used to map out the common, deep and superficial peroneal nerves.
With intraoperative neuromonitoring, the surgeon was able to confirm that conduction across the compression site was viable and could distinguish functional nerve tissue from non-functioning nerve tissue. Without proper identification of motor and sensory branches of neural tissue, the surgeon may have inadvertently removed functional motor neural tissue rather than sensory or non-functional tissue. This progression of events would have resulted in further weakness to the leg and not sufficient relief of pain. The surgeon was able to lesion the non-motor nerve tissue to relieve the patient’s pain while maintaining and decompressing the motor nerve tissue for the patient. The final result? Her pain has been alleviated and her ability to move and walk have improved.
Axis Neuromonitoring provides high-quality intraoperative neurophysiological monitoring (IONM). For more information about neuromonitoring and how our practices create the best patient outcomes, call 888-344-2947 or visit https://www.axisneuromonitoring.com.
