February 12, 2026 | Nerve Pain
2 minute read
One of the most important intraoperative decisions a peripheral nerve surgeon must make is whether an injured nerve should be decompressed or transected. These terms are sometimes used interchangeably with “excision,” but that is not technically correct.
Excision implies complete removal of a structure—such as a tumor or cyst. Peripheral nerves, however, are not removed from their origin. When a nerve is transected, the proximal end remains connected to the spinal cord and brain. Because that connection persists, the nerve remains biologically active, and the cut end must be carefully managed to prevent the formation of a painful neuroma.
A helpful analogy is a frayed electrical wire that remains plugged into an outlet. Even though the wire is cut, current still flows to its end. Just as an exposed power line must be insulated to prevent injury, a transected nerve ending must be treated appropriately to avoid ongoing pain signals.
Returning to the surgical decision-making process: once a nerve has been decompressed—meaning external sources of compression such as scar tissue, enlarged vessels, or lymphatic structures have been relieved—the surgeon must assess the nerve’s intrinsic health and its potential for recovery. This evaluation relies on several intraoperative criteria.
Indicators of viability may include restoration of blood flow through the vasa nervorum, a supple and elastic texture rather than a firm or fibrotic consistency, and preservation of normal fascicular architecture visible through a healthy, translucent epineurium. When these features are present, the nerve may retain meaningful regenerative potential, and decompression alone may be sufficient.
Conversely, if these signs are absent, the nerve may be irreversibly damaged. In such cases, continued preservation can perpetuate pain rather than function. Transection at the healthiest-appearing segment, followed by appropriate management of the proximal nerve end, may provide a more reliable path to symptom relief.
This decision is nuanced and depends on multiple additional clinical and intraoperative factors. For that reason, evaluation by an experienced peripheral nerve surgeon is critical. Just as important is patient understanding of the long-term implications of either decompression or transection. A clear grasp of these possibilities allows patients to prepare realistically for surgery and to better interpret their recovery and postoperative sensations over time.
