Lower Extremity Nerve Decompression Surgery Improves Quality Of Life By Lowering Neuropathy Symptoms In Patients With And Without Diabetes
Tirzah M. Fakkel, MD, Utrecht Medical Center, Utrecht, Netherlands
Introduction
Patients with diabetes mellitus have more focal neuropathies than those without diabetes. The symptoms of chronic compression of the peroneal and tibial nerves resembles symptoms seen in diabetic sensorimotor polyneuropathy, but there is reason for optimism in patients with superimposed entrapment neuropathies. Lower extremity nerve decompression (LEND) surgery removes the entrapment component in neuropathy and reduces pain. How this effects quality of life at the long-term is unknown. Our study aim is to assess the long-term effects of LEND surgery on quality of life, neuropathy symptoms and to identify predictors of surgical outcome.
Methods
Patients who underwent LEND-surgery between September 2017 and March 2019 are prospectively being followed at the Plastic Surgery outpatient clinic of our hospital. The common peroneal nerve, superficial peroneal nerve, deep peroneal nerve, and tibial nerve at the tarsal tunnel and at the soleal sling were decompressed if a Tinel sign is present. The primary study endpoint of this study was quality of life, as measured with the Norfolk QoL-DN questionnaire. Secondary outcome measures were predictors of surgical outcome and change in Michigan Neuropathy Screening Instrument (MNSI) scores. Patients were evaluated at baseline and at different time points postoperatively (short-term: <6 months, mid-term: 6-12 months and long-term: >12 months). Predictors of surgical outcome, such as medical history, disease duration, severity of symptoms and duration of follow-up, were investigated using multivariable linear regression analysis.
Results
60 patients were operated, 49 unilaterally and 11 bilaterally, with a median follow-up time of 12.0 months (interquartile range (IQR): 6.0-17.0) after LEND-surgery. Complete data of thirty patients, 23 men and 7 women, were available for mid-term and long-term follow-up analyses. Median age was 68.0 years (IQR: 63.3-77.5), of which the majority were diabetic subjects (type 1 diabetes: 6.7%, type 2 diabetes: 83.3%, no diabetes: 6.7%). Norfolk QoL-DN total scores significantly improved post-operatively (baseline: median 46.5 points (35.0-62.0) vs. median 38.5 points (20.0-61.8), at a median follow-up of 13.0 months (9.0-18.3, p=0.026). MNSI scores significantly improved from 7.0 (5.0-9.0) to 3.0 (0.0-7.0), p=0.0004. Predictors of the Norfolk QoL-DN total score were: time to follow-up (p=0.011) and hypertension (p=0.043).
Conclusion
LEND-surgery improves quality of life and reduces symptoms of neuropathy in patients with operated super-imposed compression neuropathies of the lower extremity. Length of follow-up and hypertension are significant predictors of the Norfolk QoL-DN total score after LEND surgery.
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