Surgical Treatment of Peripheral Neuropathy: Outcomes from 100 Consecutive Decompressions
Juan M. V. Valdivia, MD, A. Lee Dellon, MD, Martin E. Weinand, MD and Christopher T. Maloney, Jr., MD
Since 1992 it has been reported that patients with diabetes mellitus recover sensibility and obtain relief of pain from neuropathy symptoms by decompression of lower-extremity peripheral nerves. None of these reports included a series with more than 36 diabetic patients with lower-extremity nerves decompressed, and only recently has a single report appeared of the results of this approach in patients with nondiabetic neuropathy. No previous report has described a change in balance related to restoration of sensibility. A prospective study was conducted of 100 consecutive patients (60 with diabetes and 40 with idiopathic neuropathy) operated on by a single surgeon, other than the originator of this approach, and with the postoperative results reviewed by someone other than these two surgeons. Each patient had neurolysis of the peroneal nerve at the knee and the dorsum of the foot, and the tibial nerve released in the four medial ankle tunnels. After at least 1 year of follow-up, 87% of patients with preoperative numbness reported improved sensation, 92% with preoperative balance problems reported improved balance, and 86% whose pain level was 5 or greater on a visual analog scale from 0 (no pain) to 10 (the most severe pain) before surgery reported an improvement in pain. Decompression of compressed lower-extremity nerves improves sensation and decreases pain, and should be recommended for patients with neuropathy who have failed to improve with traditional medical treatment.
The susceptibility and propensity of peripheral nerves in patients with diabetes mellitus to be compressed by normal anatomical structures has been well recognized and reviewed. Surgical decompression for the treatment of symptoms due to superimposed peripheral nerve entrapment syndromes in patients with diabetes has been described as having good clinical outcomes.The results of these studies reflect a promising alternative for patients with symptomatic neuropathy due to diabetes, who have traditionally been told that besides tight glycemic control, the only other treatment for their symptoms is neuropathic pain medication. However, none of these reports included a series with more than 36 diabetic patients with lower-extremity nerves decompressed, and only recently has a single report appeared of results of this approach in patients with nondiabetic neuropathy.No previous study has described a change in balance associated with restoration of sensibility, although the intuitive relationship of progressive loss of plantar sensibility and progressive loss of balance (sway) has been demonstrated recently. This article evaluates peripheral nerve decompression in the lower extremity of a consecutive series of patients with diabetic and nondiabetic neuropathy, examining the outcomes of pain relief, decrease in pain medication use, improvement in sensibility, and improvement in balance.
Journal of the American Podiatric Medical Association Volume 95 Number 5 451-454 2005