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Open vs Retractor-Endoscopic In Situ Decompression of the Ulnar Nerve in Cubital Tunnel Syndrome: A Retrospective Cohort Study

Dützmann, Stephan MD*; Martin, K. Daniel MD; Sobottka, Stephan MD, PhD; Marquardt, Gerhard MD, PhD*; Schackert, Gabriele MD, PhD; Seifert, Volker MD, PhD*; Krishnan, Kartik G. MD, PhD§

doi: 10.1227/NEU.0b013e3182846dbd
Research-Human-Clinical Studies

BACKGROUND: Both open ulnar nerve decompression and retractor-endoscopic ulnar nerve decompression have been shown to yield good results. However, a comparative evaluation of the techniques is lacking.

OBJECTIVE: To compare the results of open and endoscopic surgery in cubital tunnel syndrome.

METHODS: One hundred fourteen patients undergoing open (n = 59) or endoscopic (n = 55) decompression of the ulnar nerve for cubital tunnel syndrome were retrospectively compared. The long- and short-term outcomes were compared with respect to the time until return to full activity and the duration of postoperative pain. Additionally, matched pairs between the 2 groups were chosen for analysis (n = 34).

RESULTS: Long-term results in the open vs endoscopic groups were as follows: excellent results, 54.2% vs 56.4%; good results, 23.8% vs 32.7%; fair results, 20.3% vs 9.1%; and poor results, 1.7% vs 1.8%, respectively. For the matched pairs, the results had similar significance levels (P = .84). The times until return to full activity in the open vs the endoscopic groups were as follows: 2 to 7 days, 18.6% vs 76.4%; 7 to 14 days, 55.9% vs 10.9%; and > 14 days, 25.4% vs 12.7% (P < .001 between nonmatched and matched pairs). The durations of postoperative pain in the open vs the endoscopic groups were as follows: 1 to 3 days, 45.8% vs 67.3%; 3 to 10 days, 42.5% vs 25.4%; and > 10 days, 11.7% vs 7.3% (P =.04 for nonmatched and P = .05 for matched pairs).

CONCLUSION: There are no significant differences in long-term outcomes after open and retractor-endoscopic in situ decompression of the ulnar nerve in cubital tunnel syndrome. The short-term results are significantly better in endoscopic surgery.

*Department of Neurological Surgery, Johann Wolfgang von Goethe University, Frankfurt/Main, Germany

Department of Neurological Surgery, Carl Gustav Carus University Hospital, Dresden, Germany

§Department of Neurological Surgery, Justus Liebig University, Giessen, Germany

Correspondence: Kartik G. Krishnan, MD, PhD, Head of Division, Reconstructive Neurosurgery, Department of Neurosurgery, Justus Liebig University, Klinikstrasse 33, D-36392 Giessen, Germany. E-mail:

Parts of this article were presented at the Meeting of the German Society of Neurosurgery, Section Peripheral Nerve Surgery; October 10, 2010; Oldenburg, Germany; and at the Annual Meeting of the American Peripheral Nerve Society; January 14, 2012; Las Vegas, NV.

Received May 18, 2012

Accepted December 10, 2012

Copyright © by the Congress of Neurological Surgeons