Comparison of the Effects of Various Decompression Patterns of Peripheral Nerves in Diabetic Neuropathy

The presence of compressive neuropathy overlying an existing diabetic neuropathy in symptomatic patients and surgical decompression of these compressed nerves in selected patients in a number of series have demonstrated that diabetic patients with neuropathy, but still having positive Tinel signs, can benefit from the releasing procedures. These include the decompression of the peripheral nerves in specific sites by releasing the external limiting bands and adding only epineurolysis, if necessary. In a previous experimental study, the authors determined that these procedures could not insure adequate decompression to the nerves, and they underwent perineurolysis to augment the effects.

In the current clinical study, the lower extremities of 20 patients with diabetic neuropathy were treated. Randomly, one leg was treated by external release and epineurolysis, as performed by others, and the other leg was treated in the same way, but a perineurolysis was also added. The patients were assessed by estimation of two-point discrimination distance and one- and two-point pressure values by using the pressure specified sensory device (PSSD).

VAS scores of the pain were improved in the next day assessment and continued through 6 months in both groups. Statistically, the difference between the times of evaluation was significant. But there was no significant difference between the groups. Sensory recovery also improved in both groups on the next day. Statistically, the difference between the times of evaluation was also significant, as it was between groups.

The main structure in maintaining the integrity of peripheral nerve tissue is the perineurium. This may be the prime concern in diabetic neuropathy, because hyperglycemia results in endoneurial edema, which can cause cessation of circulation at the perineurial level. If compartment syndrome is defined as “a group of symptoms and signs occurring together that result from increased pressure within a limited space, compromising the circulation and function of the tissues of that space,” then diabetic neuropathy may be considered a type of “compartment syndrome.” Hence, treatment is obvious: perineurotomy, equivalent to fasciotomy in other tissues. This study revealed that adding internal decompression to external release doubled the effect in reducing derangement of the peripheral nerves in diabetics and offered cause for further optimism in the treatment of diabetic neuropathy.