Decompression nerve surgery for diabetic neuropathy: a structured review of published clinical trials

Decompression nerve surgery for diabetic neuropathy: a structured review of published clinical trials

James W Albers,1 Ryan Jacobson2 1Department of Neurology, University of Michigan Medical School, Ann Arbor, MI, USA; 2Department of Neurology, Rush University Medical Center, Chicago, IL, USA Aim: To assess lower extremity decompression nerve surgery (DNS) to treat the consequences of diabetic dista...

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Autores principales: Albers JW, Jacobson R
Formato: article
Lenguaje:EN
Publicado: Dove Medical Press 2018
Materias:
diabetic neuropathy
painful neuropathy
neuropathy treatment
Specialties of internal medicine
RC581-951
Acceso en línea:https://doaj.org/article/3715189abcb947cdaae6cd44a8b6a7a4
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spelling oai:doaj.org-article:3715189abcb947cdaae6cd44a8b6a7a42021-12-02T04:01:00ZDecompression nerve surgery for diabetic neuropathy: a structured review of published clinical trials1178-7007https://doaj.org/article/3715189abcb947cdaae6cd44a8b6a7a42018-09-01T00:00:00Zhttps://www.dovepress.com/decompression-nerve-surgery-for-diabetic-neuropathy--a-structured-revi-peer-reviewed-article-DMSOhttps://doaj.org/toc/1178-7007James W Albers,1 Ryan Jacobson2 1Department of Neurology, University of Michigan Medical School, Ann Arbor, MI, USA; 2Department of Neurology, Rush University Medical Center, Chicago, IL, USA Aim: To assess lower extremity decompression nerve surgery (DNS) to treat the consequences of diabetic distal symmetric peripheral neuropathy (DPN). Research design and methods: MEDLINE, PubMed, and related registries were searched through December 2017 to identify randomized, quasi-randomized or observational trials that evaluated the efficacy of lower extremity DNS on pain relief (primary outcome) or other secondary outcomes. Observational studies were included, given investigators’ reluctance to use sham surgery controls. Outcome effect size was estimated, and a weighted average was calculated. Results: Eight of 23 studies evaluated pain relief, including a double-blind randomized controlled trial (with a sham surgery leg), an unblinded trial with a nonsurgical control leg, and 6 observational studies. All reported substantial pain relief post-DNS with average effect sizes between two and five. Unexpectedly, the double-blind trial showed improvement in the sham leg comparable to the DNS leg and exceeding the improvement observed in the nonsurgical leg in the unblinded study. Sensory testing showed generally favorable results supporting DNS, and nerve conduction velocities increased post-DNS relative to deterioration in controls. Ultrasound revealed fusiform nerve swelling near compression sites. Morphological results of DNS were generally favorable but inconsistent, whereas hemodynamic measures showed a positive effect on arterial parameters, as did transcutaneous oximetry (improved microcirculation). The incidence of initial and recurrent neuropathic diabetic foot ulcers appeared reduced post-DNS relative to the contralateral foot (borderline significant). Conclusion: The data remain insufficient to recommend DNS for painful DPN, given conflicting and unexpectedly positive results involving sham surgery relative to unblinded controls. The generally supportive sensory and nerve conduction results are compromised by methodological issues, whereas more favorable results support DNS to prevent new or recurrent neuropathic foot ulcers. Future studies need to clarify subject selection vis-à-vis DPN vs superimposed compressed nerves, utilize appropriate validated instruments, and readdress use of sham surgical controls in light of recent results. Keywords: diabetic neuropathy, painful neuropathy, neuropathy treatmentAlbers JWJacobson RDove Medical Pressarticlediabetic neuropathypainful neuropathyneuropathy treatmentSpecialties of internal medicineRC581-951ENDiabetes, Metabolic Syndrome and Obesity: Targets and Therapy, Vol Volume 11, Pp 493-514 (2018)
institution DOAJ
collection DOAJ
language EN
topic diabetic neuropathy
painful neuropathy
neuropathy treatment
Specialties of internal medicine
RC581-951
spellingShingle diabetic neuropathy
painful neuropathy
neuropathy treatment
Specialties of internal medicine
RC581-951
Albers JW
Jacobson R
Decompression nerve surgery for diabetic neuropathy: a structured review of published clinical trials
description James W Albers,1 Ryan Jacobson2 1Department of Neurology, University of Michigan Medical School, Ann Arbor, MI, USA; 2Department of Neurology, Rush University Medical Center, Chicago, IL, USA Aim: To assess lower extremity decompression nerve surgery (DNS) to treat the consequences of diabetic distal symmetric peripheral neuropathy (DPN). Research design and methods: MEDLINE, PubMed, and related registries were searched through December 2017 to identify randomized, quasi-randomized or observational trials that evaluated the efficacy of lower extremity DNS on pain relief (primary outcome) or other secondary outcomes. Observational studies were included, given investigators’ reluctance to use sham surgery controls. Outcome effect size was estimated, and a weighted average was calculated. Results: Eight of 23 studies evaluated pain relief, including a double-blind randomized controlled trial (with a sham surgery leg), an unblinded trial with a nonsurgical control leg, and 6 observational studies. All reported substantial pain relief post-DNS with average effect sizes between two and five. Unexpectedly, the double-blind trial showed improvement in the sham leg comparable to the DNS leg and exceeding the improvement observed in the nonsurgical leg in the unblinded study. Sensory testing showed generally favorable results supporting DNS, and nerve conduction velocities increased post-DNS relative to deterioration in controls. Ultrasound revealed fusiform nerve swelling near compression sites. Morphological results of DNS were generally favorable but inconsistent, whereas hemodynamic measures showed a positive effect on arterial parameters, as did transcutaneous oximetry (improved microcirculation). The incidence of initial and recurrent neuropathic diabetic foot ulcers appeared reduced post-DNS relative to the contralateral foot (borderline significant). Conclusion: The data remain insufficient to recommend DNS for painful DPN, given conflicting and unexpectedly positive results involving sham surgery relative to unblinded controls. The generally supportive sensory and nerve conduction results are compromised by methodological issues, whereas more favorable results support DNS to prevent new or recurrent neuropathic foot ulcers. Future studies need to clarify subject selection vis-à-vis DPN vs superimposed compressed nerves, utilize appropriate validated instruments, and readdress use of sham surgical controls in light of recent results. Keywords: diabetic neuropathy, painful neuropathy, neuropathy treatment
format article
author Albers JW
Jacobson R
author_facet Albers JW
Jacobson R
author_sort Albers JW
title Decompression nerve surgery for diabetic neuropathy: a structured review of published clinical trials
title_short Decompression nerve surgery for diabetic neuropathy: a structured review of published clinical trials
title_full Decompression nerve surgery for diabetic neuropathy: a structured review of published clinical trials
title_fullStr Decompression nerve surgery for diabetic neuropathy: a structured review of published clinical trials
title_full_unstemmed Decompression nerve surgery for diabetic neuropathy: a structured review of published clinical trials
title_sort decompression nerve surgery for diabetic neuropathy: a structured review of published clinical trials
publisher Dove Medical Press
publishDate 2018
url https://doaj.org/article/3715189abcb947cdaae6cd44a8b6a7a4
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