Role of Surgical Decompression of Lower Extremity Nerves in Painful Neuropathy (P06.152)

Abstract

Objective: To assess the efficacy of surgical decompression of lower extremity nerves in painful neuropathy. Background Surgical decompression of peripheral nerves is being increasingly used as an alternative approach to treatment for painful neuropathy. The procedure is however unproven (Neurology 66:1805–1808, 2006). In this prospective study, 4 patients were evaluated for benefits of decompression surgery. Design/Methods: 4 consecutive patients (3W, 1 M; mean age 53), who had already agreed to undergo decompressive surgery for their painful peripheral neuropathy underwent the following evaluations prior to surgery and at 3- and 6 months after surgery: directed history including the 11 point numerical rating of pain scale (0-10), a directed examination, nerve conduction study and skin biopsy. Total neuropathy score (TNS) was calculated. Quality of life (QoL) questionnaire (SF36) form was also administered. Surgical procedure consisted of decompression of medial plantar, lateral plantar, and calcaneal nerves at the tarsal tunnel region, common peroneal at fibular head, and deep peroneal nerve at the dorsal foot. Results: All patients had documentation of small fiber>larger fiber neuropathy and had reduced intraepidermal fiber density on skin biopsy. Neuropathy was from diabetes (2), glucose intolerance (1), and idiopathic (1). Mean TNS scores before and after surgery (6 month follow-up)were as follows: symptom score (3.2/3.2), examination score (5.2/5.25), nerve conduction score (3.2/4.0), and total neuropathy score (11.7/12.5). The mean pain and QoL(SF 36)scores from baseline to 6 months after surgery were 10/6.7 and 34/64 respectively. Overall 3 of 4 showed subjective improvement in pain and QoL. Postoperative complications included: serous drainage (1)and wound Infection requiring antibiotics and admission (1). Conclusions: Subjective improvement in pain and QoL can occur after decompressive surgery in painful neuropathy patients despite lack of improvement in objective measures of neuropathy. Supported by: The Neuropathy Association. Disclosure: Dr. Chaudhry has received personal compensation for activities with Novartis. Dr. Chaudhry has received personal compensation in an editorial capacity for the Neurologist. Dr. Chaudhry has received royalty payments from Abbott Laboratories, Inc. and Johnson & Johnson. Dr. Belzberg has nothing to disclose. Dr. Rosson has received (royalty or license fee or contractual rights) payments from Aegeria, LLC.Dr. Rosson has received research support from Lifecell, Corp.