J Reconstr Microsurg 2006; 22 - A013
DOI: 10.1055/s-2006-949683

Surgical Treatment of Peripheral Neuropathy: Outcomes from 200 Consecutive Surgical Cases

Christopher Maloney 1, 2, A. Lee Dellon 1, 2, Juan Valdivia 1, 2, Martin Weinand 1, 2
  • 1Institute for Plastic Surgery and Peripheral Nerve Surgery, Johns Hopkins, Tucson, USA
  • 2University of Arizona, Tucson, USA

Two hundred consecutive patients with neuropathy treated surgically by decompression of multiple nerves of the peroneal and tibial systems were prospectively evaluated. The objective was to quantify outcomes related to pain relief, sensory recovery, balance improvement, and the reduction in pain medication usage.

Records of 200 consecutive patients with diabetic and non-diabetic neuropathy, treated surgically by multiple nerve decompression, were reviewed prospectively. Data analyzed included changes in the visual pain analog scale, sensation improvement, reduction in pain medication requirement, and complications. All patients underwent a tarsal tunnel release and neurolysis of multiple lower extremity nerves of the tibial and peroneal systems as a concomitant part of the procedure. Patients offered surgical intervention had documented sensory abnormalities using neurosensory testing with the PSSD and had a positive Tinel's sign on examination over the involved nerve. Patients were contacted by telephone to confirm the long-standing symptom relief.

Overall, 85.6% of patients reported improvement in sensation, 92.1% balance improvement, and 86.5% reported decrease in pain medication requirement. More than 70% reported a decrease in the pain scale of more than 5 points. There were no reportable major perioperative complications requiring hospital admission or deaths related to the procedure. Minor complications were uncommon and patient satisfaction was high.

Similar to experiences 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 determines surgical candidates. In properly selected patients with neuropathy, decompression and neurolysis of compressed lower extremity nerves improves sensation, decreases pain and pain medication requirement, improves balance, and decreases the incidence of lower extremity ulcerations.