International Physician Update

A First-Time Surgical Approach Saves a Leg

Allan Belzberg did a daring sciatic nerve repair on Derrick Goodrich.

 It doesn’t matter whether your hip’s shattered by friendly fire or the real thing,” says Derrick Goodrich. “You still can’t walk.”

Goodrich, 23, joined the Army from his home in Gillette, Wyoming, carrying on a family tradition.  But in April 2003, two weeks into his tour in Iraq near the Syrian border, the young man was struck by a bullet from close range—an accidental discharge from a gun behind him.

Goodrich didn’t know then—they’d told him shock kept him from moving his leg—but the impact had vaporized five inches of his sciatic nerve. It was back in the U.S., at Walter Reed Military Hospital, that he learned the extent of his injury.  Saving his leg looked hopeless.  “They told me amputation and a prosthesis would
make it easier for me to get around,” he says.

But Goodrich pressed his physicians to seek a second opinion.  And so it was that last November, Hopkins neurosurgeon Allan Belzberg tried a gutsy approach to restoring sciatic nerve function. “This hadn’t been tried here before,” Belzberg explains. “Even I thought it a little bold. Going near the spinal cord puts bladder and bowel function at risk. But I felt Derrick had a chance.”

The largest nerve in the body, the sciatic originates from lumbar and sacral spinal nerve offshoots that meet in one nerve sheath deep in the pelvis.  “The pelvis is difficult real estate,” says Belzberg—a tough area to expose.  At first, Belzberg thought the nerve damage might be well away from where spinal nerves exit the pelvis. But a clean proximal end of the sciatic nerve didn’t exist. So he decided to bypass the nerve’s natural pelvic route, instead connecting the sural nerve graft directly to spinal nerves as they exit the spine at one end, and to the uninjured part of the sciatic nerve at the other.

A laminectomy freed the spinal cord from surrounding vertebral bone, giving access to the spinal nerves. Belzberg isolated the appropriate ones to direct into the graft. He then threaded the sural nerve through a silicone tube he’d eased under Goodrich’s skin and muscle from the near-spine incision to a second incision in the buttocks. He pulled the tube out and, under a microscope, attached the nerve’s ends using the neural equivalent of super glue—an eight-hour surgery. Then they waited.

Goodrich now can stand and bend his leg. “It’s too early to know what he’ll regain below the knee,” says Belzberg, “but things look very promising.  Derrick’s told me he’s keen to tell the world that many nerve injuries can be repaired. ‘Tell them to stop cutting peoples’ legs off,’ he’s said.”