Dave Steinbarth’s life changed drastically 30 years ago while he was driving on the Stevenson Expressway.
About 5 a.m., Steinbarth dozed off near a west suburban exit. When he opened his eyes, Steinbarth realized he was just inches from an overpass — and in a knee-jerk reaction, he tried to get out of the car.
Only his left foot was out of the car before it flipped, crushing his leg.
Seven years and nearly 20 surgeries later, Steinbarth decided to have his severely damaged left leg amputated below the knee.
And after decades of intense nerve pain, Steinbarth is finally feeling some relief after a procedure performed at Northwestern Memorial Hospital last November called targeted reinnervation. The procedure was created by two Chicago doctors, Gregory Dumanian, chief of plastic surgery at Northwestern, and Todd Kuiken, Northwestern physiatrist and director of the Center for Bionic Medicine at the Rehabilitation Institute of Chicago.
“I have seen a dramatic improvement in the level of pain that I’ve experienced just from the past three months,” said Steinbarth, 53, who lives in Woodridge. “I’m not having these several spikes in the pain anymore and these sharp shooting pains that I used to get periodically. All of that seems to have just been alleviated.”
It’s a technique that surgeons say can revolutionize the way amputations are performed and minimize the chronic nerve pain millions of amputees feel. A $2.4 million U.S. Department of Defense grant for a four-year study of the procedure was just approved for surgeons to perform the procedure at Northwestern and three other national hospitals.
In all, 200 patients will have the procedure as part of the study. The other hospitals are Walter Reed Army Medical Center, in Washington, D.C., and the University of Washington Medical Center and Harbor View Medical Center, both in Seattle.
Without this procedure, patients typically undergo a “burying in” technique — burying severed nerves under soft tissue.
According to the Department of Defense, 1,573 active-duty military personnel had major limb amputations from 2001 through 2014 because of combat-related injuries. Others lose limbs in motor vehicle or industrial accidents, and in some cases, from diabetes.
“We have millions of amputees from the wars. I think they deserve better than concepts from World War I for managing their lives,” Dumanian said. “If the study shows that targeted reinnervation-style treatment of nerve endings is beneficial, this could then become the standard for all amputations, preventing the neuromas and preventing the phantom limb pain by giving the nerves somewhere to go and something to do, at the time of the amputations.”
‘The pain story is much bigger than anything else’
Dumanian and Kuiken created the procedure about 10 years ago. Their goal was to help amputees better use their prostheses by connecting the nerves in amputated arms to the chest muscles to let the nerves grow.
By reassigning the nerves, doctors made it possible for people who had upper-arm amputations to control their prosthetic devices by thinking about the action they wanted to perform. It also allowed them to feel some of the sensations of the hand they no longer had by touching the area of the chest that the nerve was connected to.
But the doctors quickly realized that connecting severed nerves to healthy muscles also helped patients with neuromas — the chronic local pain of a cut nerve ending.
The procedure meant far more than helping amputees with prosthetic control, Dumanian said: “The pain story is much bigger than anything else.”
After performing the procedure on 26 patients, doctors worried the pain level would be worse. But the opposite happened.
The doctors reviewed patients’ pain medicine, level of prosthetic function and how much they wore their prostheses. Of 26 patients, just three still experienced pain — and that was in nerves not affected by the procedure.
So Dumanian drafted the grant proposal, and in January, the two doctors performed three surgeries as part of the study. They hope the procedure can greatly help amputees living with extreme pain every day.
For a year after his amputation, Steinbarth dealt with phantom pain — he said it felt like constant frostbite. Then came what he calls “the real actual pain below the knee.”
The phantom limb pain “would feel like you had either an ache, a burning pain or an itch. It’s very, very strange. It was very awkward,” Steinbarth said. “And then the nerve pain is what really just started kicking in. I’ve been dealing with it ever since.”
Three months after the reinnervation surgery, Steinbarth is back to wearing his prosthetic leg, which attaches just below the knee. He also takes less pain medicine, he said.
“Where I am today versus where I was six months ago, I would say at least 50 to 60 percent improvement,” he said.
It’s a relief Steinbarth — chief of U.S. sales for La Preferida, his family’s company — couldn’t have imagined after years of agonizing pain at times.
“I often thought, ‘What’s the purpose of me going through all this,’ and I was hoping that maybe in the end, I might be able to help others. Hopefully by going through this process [and talking about it], I can,” Steinbarth said.
The father of three girls, ages 26, 13 and 11, hopes to be a bit more active.
“Prior to this surgery, it would really impede my ability to interact with them and do things because I would just say, ‘It hurts too much’ or ‘I have to take it [the prosthetic] off and rest.’” Steinbarth said. “Now, I’m going to be doing a lot more outdoor activities with my girls.”
