These neuropathies may be caused by inflammation and is important for physician to recognize" that not all neuropathies that occur in the postsurgical setting are due to mechanical factors, such as compression, transection or stretching of nerves during surgery," according to P. James Dyck. He points out that Inflammatory mechanisms can also be causative, and these presenting as pain and weakness in a focal, multifocal or diffuse pattern.

In 23 patients with unexplained postsurgical neuropathies, nerve biopsies showedincreased inflammation in most patients, as well as ischemic nerve injury.

In all 21 cases of biopsy-confirmed postsurgical inflammatory neuropathy, neuropathies developed within 30 days of a surgical procedure.

The neuropathies were focal in 6 patients, multifocal in 11, and diffuse in 4.

Dyck et al stated:

"If a neuropathy occurs after a delay or in a territory remote from the surgical site, an inflammatory-immune mechanism should be considered,” and “Focally increased T2 nerve signal and enlargement within nerve segments on MRI sometimes provided another clue to the inflammatory aetiology,"

Electrophysiologic testing showed axonal damage in nearly all cases.

Treatment of postsurgical neuropathies

Of the 21 patients with biopsy-confirmed postsurgical inflammatory neuropathy, 17 were treated with immunotherapy. Fifteen received intravenous methylprednisolone (12 weekly doses of 1 g), 1 received oral steroids, and 1 received intravenous immunoglobulin, the median neuropathy impairment score improved significantly from 30 at the initial evaluation to 24 at last follow-up.

Pain improved first and weakness followed.

Although it is unclear what the true incidence of postsurgical inflammatory neuropathy is,the authors think it is relatively common, but underrecognized.

Based on their findings inflammation seems an important mechanism of nerve injury in postsurgical cases. Specific insight in who to treat and who will respond is still unclear.

October 2010, Jan M. Keppel Hesselink, MD, PhD