Biologic Basis of Nerve Decompression Surgery for Focal Entrapments in Diabetic Peripheral Neuropathy

Abstract

The most recent (2011) National Diabetes Fact Sheet states the tally of diagnosed and undiagnosed diabetes cases in the United States is approaching 25 million, and another 79 million are prediabetic. Of the diabetes patients, 60-70% suffer from mild to severe neuropathy.1 This combined loss of sensory and motor control in diabetic limbs is usually considered an irreversible, progressive process. Patients suffering from these losses are at significantly higher risk for development of foot ulceration, frequently leading to infection, and minor or major limb amputation. 2-8However, a review of surgical decompression literature addressing focal nerve entrapment suggests that several diabetic sensorimotor polyneuropathy (DSPN) symptoms and complications are potentially partially reversible or preventable. The following review surveys current research regarding the biological basis for diabetic focal entrapment neuropathy, observational studies correlated to that biological basis, and the clinical rationale and outcomes related to nerve decompression (ND) surgery. BackgroundIt is important to note that diabetic neuropathies are heterogeneous disorders. This discussion is focused on the somatic subset described as distal symmetric peripheral polyneuropathy, classically known as "stocking-glove anesthesia." Determinants affecting the rate of development and ultimate severity of the neuropathy include: duration of diabetes and adequacy of glucose control, 9 a conclusion morphologically confirmed by Perkins et al. 10 Two separate types of focal neuropathies are recognized: mononeuropathies and entrapment.11 Mononeuropathies are felt to be the consequence of vascular injury, and are said to resolve with only supportive care management. Entrapment neuropathies (the focus of this discussion) are said to occur in up to 30% of all diabetic neuropathy 12 and are postulated to occur as the result of a "double crush" phenomena. AbstractThe most recent (2011) National Diabetes Fact Sheet states the combined diagnosed and undiagnosed number of diabetes cases in the United States is approaching 25 million, and another 79 million are prediabetic. Of the diabetes patients, 60-70% suffer from mild to severe neuropathy. This combined loss of sensory and motor control in diabetic limbs is usually considered an irreversible, progressive process. Patients suffering from these losses are at a significantly higher risk for development of foot ulceration, frequently leading to infection and partial or major limb amputation. However, a review of focal nerve entrapment surgical decompression literature suggests that several diabetic sensorimotor polyneuropathy (DSPN) symptoms and complications are potentially partially reversible or preventable. Decompression surgery represents a paradigm shift in treatment protocols because it both relieves pain and restores protective sensation, while providing significant protection against a cascade of serious foot complications. This review surveys current research regarding the biological basis for...

Acute Improvement in Intraoperative EMG Following Common Fibular Nerve Decompression in Patients with Symptomatic Diabetic Sensorimotor Peripheral Neuropathy: 1. EMG Results

“…However, the EMG results are objective and consistent with the subjective improvements reported previously. 11,19,[23][24][25][26][27] The acute and sometimes substantial improvement in EMG amplitude shown in this study is somewhat unexpected given that these patients had both diabetic neuropathy and presumed chronic impingement. Further, the improvement was seen in all age groups and disease duration.…”

Noninvasive Imaging of Peripheral Nerves

“…However, peripheral nerve maladies can impact this functionality and severely decrease a patient's quality of life. Peripheral neuropathy affects over fifteen million people, and patient recovery depends on accurately assessing the nerve damage [Sessions, and Nickerson, 2014]. Precise determination of the extent of neuronal damage can enable better diagnoses and care, thereby leading to appropriate intervention, and, accelerating the recovery process.…”

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