64727 Internal neurolysis, requiring use of operating microscope (List separately in addition to code for neuroplasty) (Neuroplasty includes external neurolysis)

Name of the Procedure:

Internal Neurolysis (requiring use of operating microscope; in addition to neuroplasty which includes external neurolysis)

Summary

Internal neurolysis is a surgical procedure that aims to free a nerve from internal binding or scar tissue using an operating microscope. Neuroplasty, involving external neurolysis, is performed in conjunction to address both external and internal nerve conditions.

Purpose

Internal neurolysis addresses compressed or entrapped nerves due to scar tissue or adhesions within the nerve structure itself. The goals are to alleviate pain, restore normal nerve function, and improve quality of life by releasing the nerve from internal constraints.

Indications

• Persistent nerve pain unresponsive to conservative treatments
• Nerve entrapment diagnosed via imaging or clinical assessment
• Symptoms of nerve dysfunction such as numbness, tingling, or muscle weakness
• Previous external neurolysis with persistent symptoms

Preparation

• The patient may need to fast for several hours before the procedure.
• Certain medications, particularly blood thinners, might need to be adjusted.
• Preoperative imaging studies like MRI or nerve conduction tests are often required.

Procedure Description

1. The patient is placed under general anesthesia.
2. The surgeon makes a small incision to access the affected nerve.
3. An operating microscope is used to provide a detailed view of the nerve structure.
4. The surgeon carefully removes any internal scar tissue or adhesions binding the nerve.
5. Neuroplasty techniques are applied to free the nerve externally if required.
6. The incision is closed with sutures and covered with a sterile dressing.

Duration

The procedure typically takes 1 to 2 hours.

Setting

The procedure is performed in a hospital operating room or a specialized surgical center.

Personnel

• Surgeon specializing in neurosurgery or orthopedic surgery
• Anesthesiologist
• Surgical nurses and technicians

Risks and Complications

• Infection at the surgical site
• Nerve damage or worsening of symptoms
• Bleeding or hematoma formation
• Scar tissue formation leading to repeat procedures

Benefits

• Reduction in chronic pain
• Improvement in nerve function
• Enhanced quality of life
• Majority of improvements are noted within a few weeks to months post-procedure

Recovery

• Immediate post-operative care involves pain management with medications.
• The patient may need to restrict physical activities for a few weeks.
• Follow-up appointments are necessary to monitor the recovery progress.
• Physical therapy might be recommended to aid in nerve healing and function restoration.

Alternatives

• Conservative treatments such as physical therapy, medications, or nerve block injections.
• Minimally invasive procedures like nerve decompression.
• Each alternative comes with its own set of pros and cons, including differences in recovery time, effectiveness, and invasiveness.

Patient Experience

• During the procedure, the patient is under anesthesia and will not feel pain.
• Post-procedure, discomfort at the incision site and mild pain are common but manageable with medications.
• Patients are usually advised to rest and avoid strenuous activities during the initial recovery period, with gradual resumption of normal activities based on the surgeon’s recommendations.