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13 SURGICAL TREATMENT OF PERIPHERAL ENTRAPMENT NEUROPATHY OF THE LOWER EXTREMITIES: OUTCOMES FROM 158 CONSECUTIVE SURGICAL CASES.
  1. J. M.V. Valdivia,
  2. C. Farley,
  3. M. Weinand,
  4. C. Maloney
  1. The Institute for Plastic Surgery and Peripheral Nerve Surgery, University of Arizona, Department of Surgery, Division of Neurosurgery, University of Arizona College of Medicine, Tucson, AZ

Abstract

Objective We report the outcome of 158 patients with peripheral entrapment neuropathy treated surgically by multiple nerve decompressions of the peroneal and tibial system. This is a promising approach for the treatment of pain, numbness, and balance disturbance in diabetic and nondiabetic patients with peripheral nerve entrapment syndromes in the lower extremities.

Methods Records of 158 consecutive patients with diabetic and nondiabetic neuropathy, treated surgically by multiple nerve decompression, were reviewed to document changes in the visual analogue scale, sensation improvement, reduction in pain medication requirement, and balance improvement. All patients underwent tarsal tunnel release and neurolysis of lower extremity nerves of the tibial and peroneal system as a concomitant part of the procedure. Patients offered surgical intervention met specific criteria including documented sensory abnormalities using neurosensory testing by the Pressure-Specified Sensory Device (PSSD) and a positive Tinel's sign on examination over the involved nerve.

Results Eighty-eight percent of the patients with preoperative numbness reported sensation improvement. Eighty-one percent of patients with balance disturbance reported improved balance after the procedure. From those patients who underwent the procedure mainly for pain relief, 83% reported an improvement in the visual analogue scale of more than 50% and 77% improved in more than 5 points of the scale. After the procedure, patients reported a decrease in their pain medication requirement (p ≥ .001), sensation improvement (p ≥ .001), and pain relief (p ≥ .001).

Conclusion Similar to experiences found in the upper extremity, nerve decompression in the lower extremity is a safe and effective procedure to improve the quality of life of patients with peripheral neuropathy secondary to nerve compression. Documentation and staging of the severity of neuropathy with neurosensory testing and the presence of Tinel's sign facilitate successful selection of surgical candidates. Decompression and neurolysis of compressed lower extremity nerves are associated with statistically significant improvement in the visual analogue scale and sensation. The great majority of patients are very satisfied with the results.

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