Treatment of a patient with small fiber pathology using nerve biopsy and grafting: a case report

Small fiber pathology is a common clinical entity with a variable clinical presentation and etiology. Unfortunately, little has been described regarding its treatment because a majority of cases are idiopathic. Hence, treatment often consists of symptomatic management of pain and autonomic dysfunction. This report describes a patient who was presented with an undiagnosed pain syndrome thought to be affecting nerves within both lower extremities and causing significant pain. A sural nerve biopsy was performed for diagnostic purposes and nerve repair was performed using Avance nerve allograft (AxoGen Inc., Alachua, FL). Light microscopic evaluation was unremarkable, but electron microscopy revealed small fiber pathology. Postoperatively, the patient experienced a complete resolution of her pain on the involved extremity. These results suggest a potential, novel approach for treatment of such cases and possible mechanisms for the patient's clinical improvement are explored.