Targeted muscle reinnervation for treatment of neuropathic pain in non-amputees – Indications and outcomes

Introduction: Targeted Muscle Reinnervation (TMR) offers a promising surgical approach to prevent and treat neuropathic pain but has primarily been utilized in amputees. This study aims to describe indications and outcomes for TMR in non-amputees. Methods: Non-amputee patients who underwent TMR for neuropathic pain at a tertiary center (2019–2024) were identified. Demographics, comorbidity, and surgical characteristics were collected through chart review. Patient satisfaction (Patient Global Impression of Change, PGIC) and quality of life (EQ-5D-5L) were assessed through a cross-sectional survey. Results: Seventy-six TMR operations were performed in 74 patients (median age 54.5 (Interquartile range [IQR]: 42.0–65.0) years, 47.3% female). Thirty-four patients (44.7%) previously underwent other peripheral nerve surgery in the same nerve distribution before TMR surgery. Most TMR surgeries were performed in the lower extremity (n=52, 68.4%), followed by the trunk (n=15, 19.8%), upper extremity (n=6, 7.9%), and head/neck (n=3, 3.9%). Six patients (7.9%) underwent revision surgery to the nerve treated with TMR. Of 45 survey respondents (60.8%, mean follow-up 2.0±1.2 years), improvement (PGIC) was reported for 82.4% of lower extremity (n=28), 88.9% of trunk (n=8), and 50.0% of upper extremity (n=2) cases. Overall, 78.7% reported improvement (25.5% very much improved, 34.0% much improved, 19.2% minimally improved). Mean EQ-5D-5L indices were 0.828 (±0.082), 0.794 (±0.056), and 0.763 (±0.024) for lower extremity, trunk, and upper extremity, respectively, comparable to the US general population (0.851±0.205). Conclusions: Non-amputees report improvement in neuropathic pain across various anatomic regions, suggesting the benefit of TMR beyond the amputee population.