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The Effect of Neurolysis on Diabetic Patients with Compressed Nerves of the Lower Extremities: A Systematic Review and Meta-Analysis
Pablo Baltodano, MD, Bakak Basdag, MS, Christopher R. Bailey, BA, Marcelo Lacayo-Baez, MD, Anne Tong, MD, Stella Seal, MLS, Mark M. Melendez, MD, MBA, Justin Broyles, MD, Michele A. Manahan, MD, Gedge D. Rosson, MD.
Johns Hopkins University, Baltimore, MD, USA.

PURPOSE: Despite well-known benefits of upper extremity nerve decompression in diabetics, utility of neurolysis on diabetic patients with lower extremity (LE) nerve compression remains controversial. Thus we sought to systematically assess and present a meta-analysis of the effect of neurolysis on pain, sensibility and postoperative incidence of ulcerations/amputations on diabetic patients with compressed nerves of the LE.
METHODS: A search of ClinicalTrials.gov and Cochrane clinical trials registries, CENTRAL (The Cochrane Library), MEDLINE, EMBASE, LILACS, CINAHL, SCOPUS and Google Scholar from 1962 to 2012, yielded 1956 citations. All the randomized or quasi-randomized controlled trials and observational cohort studies of diabetics with neurolysis of the common peroneal nerve, deep peroneal nerve or tibial nerve were systematically assessed. We included articles in any language that 1) provided information about diabetic patients who had neurolysis for symptomatic nerve compression diagnosed by (+) Tinel sign or electrodiagnostic study, and 2) quantified outcomes for pain, sensibility or ulcerations/amputations. Case reports, review articles, animal or cadaver studies, and studies with <10 patients were excluded. Analyzed outcomes included pain relief, recovery of sensibility, and postoperative incidence of ulcerations/amputations at follow up >3 months. Using validated instruments, five blinded reviewers scored the manuscripts for clinical relevance and methodologic quality. A meta-analysis of descriptive statistics was performed.
RESULTS: Ten clinical series, with a mean clinical relevance score of 76% and a mean methodologic quality score of 55%, met inclusion criteria (Table 1). These studies included 875 patients and 1053 LEs. Pain relief >3 points on visual analog scale occurred in 91% of patients; sensibility improved in 69%. Postoperative ulceration/amputation incidence was significantly reduced compared to preoperative incidence (OR=0.066, 95% CI=0.026-0.164, p<0.0001). The overall complication rate was 22% (Table 2).
CONCLUSION: Observational prospective and retrospective studies show that neurolysis significantly improves symptoms and natural history of diabetic patients with superimposed nerve compression of the LE. No randomized controlled trials have been published.


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