Clinical Outcome of Peripheral Nerve Decompression in Diabetic and Nondiabetic Peripheral Neuropathy

Abstract

Surgical decompression of peripheral nerves in patients with diabetes was reported to restore sensation and improve function. In this study, a retrospective review of 12 diabetic and 20 nondiabetic patients with lower-extremity peripheral neuropathy who underwent surgical decompression was performed. Clinical evaluation by Tinel test, muscle power examination, and 2-point discrimination were performed preoperatively, at 6 months, and between 9 and 15 months postdecompression. Clinical outcomes were classified into excellent, good, or fair based on improvement in symptoms and return of function. Thirty-two patients underwent 36 surgeries, in which 99 lower-extremity nerves were decompressed. There was a statistically significant improvement in muscle function (P < 0.001) and 2-point discrimination for the small toe (P = 0.008) and big toe (P = 0.038). At a mean of 7.7 months, 90% of patients showed significant improvement in pain and function. It is concluded that surgical decompression was associated with significant improvement in clinical outcome in patients with diabetic and idiopathic neuropathy with evidence of superimposed compression.

Surgical treatment of superimposed nerve compressions in hepatitis C neuropathy

“…[20][21][22][23][24][25][26][27][28][29] Bilateral lower extremity peripheral nerve decompressions can improve balance in patients with an underlying peripheral neuropathy. 30 Siemionow and Demir have recently written an excellent review of the pathogenesis and multidisciplinary treatment of diabetic neuropathy in the microsurgery literature, 31 and Baravarian in the podiatry literature.…”

Nerve Decompression Surgery as Treatment for Peripheral Diabetic Neuropathy

“…Ten of 13 studies were performed and evaluated in unblinded fashion or by study designer only. 21,23,[25][26][27][28][29][30][31]33 Including patients with diabetic neuropathy and idiopathic neuropathy within the same study, 21,25,30 -32 or performing decompression of different nerves in the same study, 22,23,25,29,30,32 may introduce a bias. Two studies focused on diabetic patients with a positive Tinel sign (indicative of nerve entrapment), which could represent a bias when reporting on the effect of decompression surgery in all diabetic patients.…”

“…[21][22][23][24][25][26][27][28][29][30][31][32][33] Nine of these were based on case series 21,23,[25][26][27][28][29][30]32 and 4 were of prospective design. 22,24,33,34 The lack of standardized patient inclusion criteria and outcome measures makes comparison difficult; nevertheless, improvement after decompression surgery was reported using objective 2-point sensory testing in 10 studies, 21,22,24 -26,29 -33 subjective improvement of sensation and pain in 8 studies, 22,25-27,29 -32 recovery or prevention from development of ulcers in 3 studies, 23,27,28 and reduction of pain medication in 2 studies.…”

Operative Nervendekompression an der unteren Extremität bei diabetischer Polyneuropathie

“…Die bislang vorliegenden nicht-randomisierten Studien belegen eine Verbesserung der Schmerzstärke in 70-90% (z. B. VAS 9,0 auf postoperativ 3,2; n=30; [18]), eine verbesserte Sensibilität in 60-95% der Fälle sowie eine Verhinderung von Ulcerationen und Amputation am dekomprimierten Bein [1,2,6,7,8,10,13,16,17,18] …”