Surgical treatment of peripheral neuropathy: outcomes from 100 consecutive deco

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J Am Podiatr Med Assoc. 2005 Sep-Oct;95(5):451-4.

Surgical treatment of peripheral neuropathy: outcomes from 100

consecutive decompressions.

Valdivia JM, Dellon AL, Weinand ME, Maloney CT Jr.

Division of Neurosurgery, Department of Surgery, University of

Arizona, Tucson.

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.