BACKGROUND

In this current study, we intended to search the effect of nerve decompression procedures on diabetic neuropathy cases just in the following day after surgery as well as later in the 6th months.

MATERIAL AND METHODS

Twenty – four consecutive patients with symptomatic diabetic neuropathy who underwent surgical decompression of lower extremity were entered into this patient cohort. Each patient had been previously diagnosed and treated for diabetes mellitus with oral or parenteral hyperglycemic agents by their endocrinologists. All patients had been previously diagnosed with diabetic neuropathy and presented complaining of lower extremity symptoms related to their diabetes (pain, tingling, burning, numbness).

Using an 11-point visual analog scale (VAS), each patient was asked preoperatively to rate the greatest intensity of pain associated with their neuropathy. Absence of pain was rated as 0 and the worst possible pain as 10.

Patients were screened for surgery with neurosensory testing by using a Pressure-Specified Sensory Device (PSSD). Patients were graded by using numerical grading system according to physical exam, and their values of PSSD measurement from big toe plantar surface and heel.

The common peroneal nerve was decompressed distal to the fibular neck on the lateral calf. The posterior tibial nerve and its branches were decompressed by a technique that releases 4 medial ankle tunnels: the tarsal tunnel, the medial and lateral tunnels, and the medial calcaneal tunnel. The deep peroneal nerve at the dorsum of the foot was decompressed. At a mean postoperative follow-up of 8 months, the data was interpreted to evaluate pain relief and restoration of sensation in the operated foot. The results of the preoperative, postoperative first day and postoperative sixth month were compared.

RESULTS

We found pain relief rate 80% of the patients at postoperative first day and 85% of the patients at postoperative sixth month with a preoperative complaint of pain reported excellent to good levels of pain relief after surgery. For sensory assessment of each individual area, mean two-point discrimination length’s improvement rates was found as 72.6% at postoperative first day, and 89% at postoperative sixth month which mean excellent and good improvement. According to numerical grading system results, which helps us to compare clinical state of patients and sensory measurement values, while 45.9% of postoperative first day patients show significant grade improvement, this rate increases to 75% at postoperative sixth month.

CONCLUSIONS

The improvement in peripheral nerve function after complete regeneration period in the long time was essential in peripheral nerve surgery. Any improvements in the early periods were also very important for those patients as well. Those with diabetic neuropathy were suffering from their complaints for a long time and mostly depressed for that reason. That was why they became very excited after even minor improvements and their morales were recoverd. This concept was very important for diabetic patients because improvements reassured them they were getting better after all those bad days and made them hopeful for their future and made them more concordant with their treatment offered by their physicians The authors concluded that the peripheral nerve decompression can be used effectively in the treatment of symptomatic diabetic neuropathy patients.