Medical literature on nerve regeneration statistics and J Smith

waldoputty

waldoputty

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Entire article in: http://www.bloggingtheboys.com/2016...l-literature-on-nerve-regeneration-statistics

I spent quite a bit of time searching for medical literature on nerve injuries. I found this publication that provides statistics on peroneal nerve recovery: Neurosurgery. 2004 Jun;54(6):1421-8; 1428-9 entitled "Management and outcomes in 318 operative common peroneal nerve lesions at the Louisiana State University Health Sciences Center".

This study showed very encouraging statistics (75%-84%) for 2 types of surgeries used to treat injuries substantially more severe than Jaylon Smith's case. However, one caveat is that the study's recovery milestone is grade 3 function, while a more complete recovery is needed for football. Peroneal grade 3 function means that an AFO is no longer needed for a reasonable walking gait. The paper abstract did not provide any data for higher quality functional recovery. Please note that I am not a MD or PhD, and I am only pulling information from the abstract of this article. When advising the Cowboys, Dr. Cooper should have been aware of the most relevant data. Now that I have the right search terms, I also found other articles which are more complicated.

Summary of results:
1. Suturing for severed nerves: 84% of the patients recovered grade 3 peroneal function or better. Jaylon's nerve was only stretched and not severed. Thus, the recovery probability should probably be higher than 84% and the quality of recovery is probably also higher.
2. Nerve graft for even more severe injuries: 75% of the patients with nerve grafts shorter than 6cm recovered grade 3 function or better. This is more severe than the suturing repair, but served as an additional data point for comparison.
3. The neurolysis procedure, with 88% success rate, was also mentioned but may not be applicable and required measurable nerve electrical signals of some sort. This procedure involves the use of chemicals to kill the distal portion of the nerve to relieve pain and discomfort when a nerve is compressed.
 
Kaiser

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Two reactions that would make the odds even better for Jaylon Smith.

1 - If that published in 2004 you have to think that the procedure has advanced since then. 2 - the data was taken for different surgeons with different skill levels, while Jaylon Smith had his done by one of the top surgeons in the field.
 
waldoputty

waldoputty

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Kaiser said:
Two reactions that would make the odds even better for Jaylon Smith.

1 - If that published in 2004 you have to think that the procedure has advanced since then. 2 - the data was taken for different surgeons with different skill levels, while Jaylon Smith had his done by one of the top surgeons in the field.
Click to expand...

The study evaluated results of surgeries performed over many years at the LSU center. I dont recall how many years, but probably at least 10 years. Surgery on nerves is not a trivial. Luckily Jaylon needed neither suturing or grafting.

I believe that Jaylon's surgery was more about the ACL repair. That is why it was a less severe case.
 
CalPolyTechnique

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waldoputty said:
Entire article in: http://www.bloggingtheboys.com/2016...l-literature-on-nerve-regeneration-statistics

I spent quite a bit of time searching for medical literature on nerve injuries. I found this publication that provides statistics on peroneal nerve recovery: Neurosurgery. 2004 Jun;54(6):1421-8; 1428-9 entitled "Management and outcomes in 318 operative common peroneal nerve lesions at the Louisiana State University Health Sciences Center".

This study showed very encouraging statistics (75%-84%) for 2 types of surgeries used to treat injuries substantially more severe than Jaylon Smith's case. However, one caveat is that the study's recovery milestone is grade 3 function, while a more complete recovery is needed for football. Peroneal grade 3 function means that an AFO is no longer needed for a reasonable walking gait. The paper abstract did not provide any data for higher quality functional recovery. Please note that I am not a MD or PhD, and I am only pulling information from the abstract of this article. When advising the Cowboys, Dr. Cooper should have been aware of the most relevant data. Now that I have the right search terms, I also found other articles which are more complicated.

Summary of results:
1. Suturing for severed nerves: 84% of the patients recovered grade 3 peroneal function or better. Jaylon's nerve was only stretched and not severed. Thus, the recovery probability should probably be higher than 84% and the quality of recovery is probably also higher.
2. Nerve graft for even more severe injuries: 75% of the patients with nerve grafts shorter than 6cm recovered grade 3 function or better. This is more severe than the suturing repair, but served as an additional data point for comparison.
3. The neurolysis procedure, with 88% success rate, was also mentioned but may not be applicable and required measurable nerve electrical signals of some sort. This procedure involves the use of chemicals to kill the distal portion of the nerve to relieve pain and discomfort when a nerve is compressed.
Click to expand...

Where's the link to the journal article you read?
 
waldoputty

waldoputty

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Kaiser said:
Two reactions that would make the odds even better for Jaylon Smith.

1 - If that published in 2004 you have to think that the procedure has advanced since then. 2 - the data was taken for different surgeons with different skill levels, while Jaylon Smith had his done by one of the top surgeons in the field.
Click to expand...

Feedback I got at BTB - he talks like a doctor/authority in this field providing info that I said I did not know.
:
You are correct in that his injury is likely just a simple stretch and that the nerve was not severed, per Dr. Cooper. He shouldn’t need any procedures done (i.e. nerve grafts/sutures). That’s the main reason that I’m confident he returns to full strength relatively soon.
To help clarify on how to compare the injury types: gun shot is probably the worst-case and could be classified as laceration in most cases, where full recovery isn’t as likely. The nerve has to regenerate, and sometimes never finds its way back to the muscle. Pressure from tumors typically just requires decompression of the nerve, and full function can be restored within 24 hours sometimes. The nerve usually isn’t physically damaged. It’s very similar to your leg falling asleep when you sit on the nerve wrong, and it wakes up a few minutes later. A stretch falls in between, and can range in severity depending on the percent increase in length beyond normal. His didn’t sound like it stretched too far beyond normal length, but that’s just a guess.
On a side note, Jaylon seems well-rooted in his faith. Only good can come from his spending time with Gregory, in my opinion. I think it’s the best-case scenario for #94.

by Fumbles on Oct 28, 2016 | 10:53 PM reply rec flag
 
DogFace

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waldoputty said:
Feedback I got at BTB - he talks like a doctor/authority in this field providing info that I said I did not know.
:
You are correct in that his injury is likely just a simple stretch and that the nerve was not severed, per Dr. Cooper. He shouldn’t need any procedures done (i.e. nerve grafts/sutures). That’s the main reason that I’m confident he returns to full strength relatively soon.
To help clarify on how to compare the injury types: gun shot is probably the worst-case and could be classified as laceration in most cases, where full recovery isn’t as likely. The nerve has to regenerate, and sometimes never finds its way back to the muscle. Pressure from tumors typically just requires decompression of the nerve, and full function can be restored within 24 hours sometimes. The nerve usually isn’t physically damaged. It’s very similar to your leg falling asleep when you sit on the nerve wrong, and it wakes up a few minutes later. A stretch falls in between, and can range in severity depending on the percent increase in length beyond normal. His didn’t sound like it stretched too far beyond normal length, but that’s just a guess.
On a side note, Jaylon seems well-rooted in his faith. Only good can come from his spending time with Gregory, in my opinion. I think it’s the best-case scenario for #94.

by Fumbles on Oct 28, 2016 | 10:53 PM reply rec flag
Click to expand...
Interesting speculation backed by a lot of research.
Appreciate the work.

Sounds very positive.
 
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