A Review of Therapeutic Nerve Decompression for Neuropathy in Hansen's Disease with Research Suggestions

Abstract

Nerve decompression surgery for leprosy neuritis has a long history and large literature. New understanding of the high frequency of spontaneous recovery from nerve function impairment requires re-evaluation of the value of decompression in acute nerve dysfunction with strong evidence-based protocols. Several reports and theoretical considerations suggest research avenues that might offer hope for prevention of long-term complications and relief of impairment and disabilities.

Pure neuritic leprosy presenting as ulnar nerve neuropathy: a case report of electrodiagnostic, radiographic, and histopathological findings

“…Relative compression of the nerves in their fibro-osseous tunnels can be demonstrated by imaging studies and at surgery. 18,21,35 When explored, the nerves, as in our case, have a dense fibrotic consistency. The fibrotic epineurium and external compression are thought to create relative venous obstruction, capillary stasis, edema, and ischemia.…”

“…12,21 As previously noted, leprosy typically involves major nerves at and above areas associated with compressive neuropathy. Relative compression of the nerves in their fibro-osseous tunnels can be demonstrated by imaging studies and at surgery.…”

“…Numerous reports suggest various benefits of surgical decompression, including improved neurological status, less deformity, and alleviated pain, 12,21 but the nature of these studies has called into question the true effectiveness of surgery. The literature relating to this issue has been summarized in a Cochrane review last updated in …”

“…34,35 No clear statistical benefit from surgical decompression could be demonstrated based on the existing literature, and recommendations have been made for careful randomized controlled trials. 21,35 As per Husain and Mishra, 12 we disagree with this recommendation given that the number of uncontrollable variables precludes an ability to get adequately comparable groups. The variable nature of the host response, occasional spontaneous recovery without treatment, clinical worsening during and even months after successful treatment, variable number of nerves and extent of their involvement, variable ability of individual nerves to recover from injury, inability to blind surgical trials, and inability to obtain meaningful outcome measures in the field setting where most care is given make the likelihood of obtaining a legitimate answer regarding surgical decompression in a randomized multicenter trial essentially nil.…”

Avaliação da limitação das atividades diárias e qualidade de vida de pacientes com hanseníase submetidos à cirurgia de neurólise para tratamento das neurites

“…For prevention and treatment of the neural damage, the WHO recommends oral corticotherapy and/or a surgical approach for nerve decompression (neurolysis) [6][7][8][9][10] . Until now, the evaluation of postoperative results of the neurolysis was based on pain decrease and sensorimotor function, without considering the person's perception of his/her position in life with regard to the person's culture and his/her system of values and expectations, as proposed by the International Classification of Functioning, Disability and Health (ICF) [9][10][11][12] . This study aimed at identifying the grade of limitations in daily activities and quality of life in patients submitted to neurolysis for neuritis treatment in leprosy.…”