Percutaneous image guided induction of neuroregeneration as a repair mechanism for damaged nerves.

Purpose: Up to 10% of the population is afflicted with chronic neuropathic pain, for which current treatments are often suboptimal and/or expose the patient to risks of addiction or worsening pain. {1, 2, 3}

The underlying pathophysiology affecting these patients is a permanent structural change in the nerve following trauma, infection, or systemic drug administration. {4, 5, 6, 7}

It has been shown in both in animals and in humans that exposure of nerves to specific cold temperatures for distinct periods of time across defined geographic regions can induce predictable changes in the target – namely cessation of signal transduction, Wallerian degeneration, and predictable axonal regeneration. {8, 9, 10, 11}

We hypothesized that predictable induction of these events would be useful for the replacement of an otherwise hyperirritable, symptomatic nerve damaged by trauma.

Materials and Methods: A retrospective review was done for patients that had undergone percutaneous cryoneurolysis of a peripheral nerve in a single center over a 7-year period with the intent of neural repair through induced regeneration. Clinical and imaging signs of neuroregeneration were evaluated using pre-procedure and follow-up pain scores, resolution of associated neurological symptoms, and follow-up MRI.

Results: Five patients underwent percutaneous neuroregenerative therapy during this time. All patients demonstrated clinical signs of neural regeneration on follow-up. 3 of 5 patients reported resolved pain at least 1-year post-procedure. Two patients were followed with MRI which showed normalization of muscle signal.

Conclusion: Percutaneously induced neuroregeneration may represent a novel predictable therapy via nerve replacement and repair for patients with chronically damaged nerves.