Post-surgical inflammatory neuropathy has been studied by these authors as they felt that other mechanisms maybe at play other than the usual mechanical factors (stretch, compression, contusion, transection). They analysed the clinical features, nerve conduction, imaging and biopsy of the nerves demonstrating some interesting findings indicative of an inflammatory-immune response. For example, Staff et al. (2010) found increased nerve size, abnormal biopsy (increased epineural perivascular lymphocyte inflammation, microvasculitis, ischaemic nerve injury and axon degeneration). Those treated with immunotherapy showed good improvements in pain and nerve function supporting the notion of an immune response.
Typically this kind of neuropathy is found remote to the surgical site and presents at a median time of 2 days (0-30 range). This does not fully explain a presentation that occurs on the same limb.
Overall this study suggests that the inflammatory-immune response is not uncommon and should be considered as a mechanism to guide treatment. The authors also point out that it may be difficult to distinguish between a mechanical cause and an inflammatory cause and therefore a biopsy would be required to confirm. Of course there could be concurrent mechanisms that we know occur in LBP.
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