• Sarada Sakamuri and Thomas J Wilson.
• Department of Neurology and Neurological Sciences, Stanford University, Stanford, California.
• Neurosurgery. 2020 Nov 16; 87 (6): E638-E645.

BackgroundNew or worsened neuropathic pain is common following nerve biopsy and significantly impacts quality of life.ObjectiveTo examine the impact of allograft nerve repair on the likelihood of postoperative worsened neuropathic pain following nerve biopsy.MethodsA retrospective cohort study was performed comparing standard nerve biopsy to nerve biopsy with allograft repair. Consecutive patients (N = 51) who underwent whole nerve biopsy between August 1, 2017, and August 1, 2019, by a single surgeon were evaluated for inclusion. The primary outcome was significant worsening of visual analog scale (VAS) score in the nerve distribution 6-mo postbiopsy. Secondary outcomes included significant worsening of VAS in the nerve distribution 3-wk postbiopsy and significant change in Zung Self-Rating Depression Scale 6-mo postbiopsy.ResultsIn a multivariate model, allograft nerve repair significantly reduced the likelihood of increased neuropathic pain at 6-mo postbiopsy (odds ratio 0.02, P = .03). Worsened neuropathic pain occurred in 28% of the standard nerve biopsy cohort compared to 4% of the allograft nerve repair cohort. In a multivariate model, an increase in neuropathic pain was strongly associated with an increased likelihood of self-reported depression (odds ratio 57.4, P = .01).ConclusionAllograft nerve repair significantly reduces the likelihood of postbiopsy worsened neuropathic pain compared to standard techniques. Neuropathic pain significantly impacts quality of life after nerve biopsy, and this is the first technique to demonstrate a significant reduction in neuropathic pain while maintaining the ability to harvest an adequate nerve specimen.Copyright © 2020 by the Congress of Neurological Surgeons.

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