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Surgical Treatment of Superimposed, Lower Extremity, Peripheral Nerve Entrapments with Diabetic and Idiopathic Neuropathy

Valdivia Valdivia, Juan Martin MD*; Weinand, Martin MD; Maloney, Christopher T. Jr MD; Blount, Andrew L. MD; Dellon, Arnold Lee MD, PhD§∥

doi: 10.1097/SAP.0b013e3182764fb0
Peripheral Nerve Surgery and Research

Background Although it is recognized that people with peripheral neuropathy have an increased prevalence of chronic nerve entrapment, controversy still exists over their management. The present report details the evaluation, surgical approach, and outcome of a large cohort of people with diabetic and with idiopathic neuropathy.

Methods A retrospective review of 158 consecutive patients, 96 with diabetic and 62 with idiopathic neuropathy, was done to analyze the results of neurolysis of multiple sites of chronic nerve compression in the lower extremity. Of these patients, 50 had a contralateral limb decompressed for a total of 208 limbs included in the study. Outcomes included visual analog scale (VAS) for pain in the 109 patients who had pain level greater than 8.0, measurement of the cutaneous pressure threshold for sensibility, self-reported change in pain medication usage, and self-reported change in balance.

Results With a minimum follow-up of 1 year, 88% of patients with preoperative numbness reported improvement in sensation (P < 0.001). Of the 84 patients with impaired balance, 81% reported improvement in balance. Of those whose VAS was greater than 8, 83% reported an improvement in VAS (P < 0.001). There was a concomitant reduction in pain medication usage. There was no difference in outcomes between patients with diabetic versus idiopathic neuropathy in response to nerve decompression.

Conclusions Neurolysis of lower extremity chronic nerve compressions in patients with neuropathy and superimposed nerve compressions is an effective method for relieving pain, restoring sensation, and improving balance.

From the *Department of Neurosurgery, University of Michigan, Ann Arbor, MI; †Division of Neurosurgery, Department of Surgery, University of Arizona; ‡The Institute for Plastic Surgery, and Peripheral Nerve Surgery, Tucson, AZ; Departments of §Plastic Surgery and ∥Neurosurgery, Johns Hopkins University, Baltimore, MD.

Received March 1, 2011, and accepted for publication, after revision, September 25, 2012.

Conflicts of interest and sources of funding: Dr Dellon has a proprietary interest in the Pressure-Specified Sensory Device.

Reprints: Arnold Lee Dellon, MD, PhD, The Exchange Bldg, Suite 18, Towson, MD 21204. E-mail:

© 2013 by Lippincott Williams & Wilkins