Abstract
Aim: To evaluate the progression of nerve injury in leprosy patients undergoing peripheral nerve decompression surgery. Methodology: Observational study of retrospective, descriptive-analytical cohort. In the convenience sample, individuals with leprosy who underwent peripheral nerve decompression surgery at the Casa de Saúde Santa Marcelina, Porto Velho/RO, between 2000 and 2019 were evaluated nerve by nerve, before and after surgery. Results: Note that 574 individuals underwent 2549 surgeries of the ulnar, median, tibial and/or fibular nerves. Most individuals were male (51.6%), of brown race (80.3%), multibacillary (90.9%), aged between 31 and 60 years (73.2%) and originating from other municipalities in the state of Rondônia, Northern Region of Brazil (67.4%). Most individuals maintained or improved the GD (WHO Grade of Disability), the sensory or the motor nerve function in the limbs operated. Conclusion: The improvement or maintenance of the DG was observed in more than 80% of the operated individuals. In the nerve-to-nerve analysis, considering the sensory and motor functions for all operated nerve trunks, there was an improvement or maintenance of the values presented in the preoperative period for most individuals. According to the results obtained in this study, we concluded that peripheral nerve decompression surgery was able to interrupt the progression of nerve injury in more than 80% of the operated individuals. Considering the potential of the surgery as a preventive procedure, we recommend its indication even for individuals with grade 0 of disability but that present persistent pain or neural thickening after four weeks of clinical treatment without other symptoms.
Highlights
According to the results obtained in this study, we concluded that peripheral nerve decompression surgery was able to interrupt the progression of nerve injury in more than 80% of the operated individuals
The eligibility criteria for surgery were as follows: patients diagnosed with leprosy paucibacillary (PB) or multibacillary (MB) who have: recurrent neuropathy despite the use of corticosteroids; nerve abscess; neuropathy that does not respond to systemic corticosteroid therapy for a period of four weeks; tibial nerve neuropathy; patients with contraindications to the use of corticosteroids; chronic neuropathy with late deficit and pain; progressive worsening of nerve injury, verified through tests of nerve function by the Simplified Neurological Assessment examination.[4]
Note that 623 individuals registered as leprosy patients who underwent peripheral nerve decompression surgery were selected
Summary
The state of Rondônia presented 465 new cases of the disease, corresponding to a new case detection rate of 3.83/10,000 inhabitants, the sixth highest in the country, i.e., well above the national rate for the same year and the goal recommended by the World Health Organization (WHO), which is 1/10,000 inhabitants.[3]. The burden of leprosy is related to the progression of nerve injury, which can occur even after treatment with the specific multidrug therapy (MDT), causing physical disability with consequences at work and in the social life. Peripheral nerve decompression surgery is a complementary therapy to conservative clinical treatment with systemic corticosteroids recommended by the World Health Organization (WHO). Peripheral nerve decompression surgery is considered a preventive surgery for nerve injury in leprosy and when properly indicated; it aims to prevent the progression of nerve injury, avoiding the emergence of new physical disabilities
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