Effect Of Nerve Decompression On Balance In Neuropathy Patients

Today's post from podiatrytoday.com (see link below) looks at nerve decompression surgery in the lower extremities of neuropathy patients and asks the question as to whether it's a valid treatment or not. Nerve decompression surgery is a minimally invasive surgical procedure to relieve pressure caused by a neuroma which is basically a pinched or entrapped nerve. The question for readers is whether their own neuropathy symptoms are actually caused by trapped nerves or not. In most cases of neuropathy, we're not looking at trapped nerves but damaged nerves caused by a variety of other possible causes. However, considerable numbers of people do have trapped nerves in their backs, legs or arms, or elsewhere and nerve decompression surgery is a treatment possibility. The study mentioned here looked a stability in those patients after surgery and concluded that there was little evidence to show an improvement but some surgeons claim a significant improvement in both balance and pain levels. The jury still seems to be out but it may be worth talking over with your specialist, if your neuropathy stems from nerve entrapment.
  

Does Nerve Decompression Improve Static Balance In Patients With Painful Diabetic Neuropathy?

 By Brian McCurdy, Managing Editor Friday, 11/21/14 |

Issue Number:

Volume 27 - Issue 12 - December 2014

A recent study questions whether nerve decompression will improve static balance in patients with diabetic neuropathy.

The study, recently published in Clinical Rehabilitation, focused on 39 patients with painful diabetic polyneuropathy. Patients had unilateral surgical nerve decompression at four sites in the lower extremity and the study used the contralateral limb as control. Researchers measured weightbearing and five variables of sway of the center of pressure with a pressure mat both with the patients’ eyes open and their eyes closed. The study authors obtained measurements preoperatively and at six and 12 months postoperatively, using the T-test for evaluation of postoperative results.

The authors concluded that there is no evidence that surgical decompression of nerves of the lower extremity in patients with painful diabetic polyneuropathy influences stability.

Stephen Barrett, DPM, FACFAS, has noted significant improvements in balance in many nerve decompression patients, but has not specifically correlated both findings over the last decade that he has performed the surgery. He notes the study focused on unilateral decompressions with the contralateral limb as a control. However, Dr. Barrett cites a 2006 study in the Annals of Plastic Surgery concluding that there was statistically significant improvement in static balance after bilateral decompression both with eyes open and eyes closed in unilaterally decompressed patients.

Dr. Barrett has found that if a patient demonstrates a positive Tinel’s sign or a positive provocation test, the success rate is up to 90 percent for a reduction in pain and 75 to 80 percent for restoration of sensation.

“In properly selected patients, peripheral nerve surgery is highly successful and more than 85 percent of my patients return to have nerve decompression done on their other extremity,” says Dr. Barrett, a Fellow and the President of the Association of Extremity Nerve Surgeons.

Although he has not studied stability after nerve decompression, Peter Bregman, DPM, says his patients have said they can walk better after the surgery due to less pain. If the pain is gone, he says the patients should have more stability in their gait if they are not fighting pain.

Dr. Bregman notes nerve decompression is only effective in patients with a diagnosed nerve compression and adds that the procedure would be contraindicated in patients with renal failure, leg edema or any active ulcers. Dr. Barrett adds that peripheral nerve decompression surgery in patients with diabetes is contraindicated in a patient who does not have adequate vascular supply or has some other comorbidity that would preclude safe surgery.

One year after nerve decompression surgery, Dr. Barrett has found patients have done very well and many relate an increased benefit from pain reduction and the restoration of sensation after 24 months. He says only a few have had to have another decompression surgery due to scar tissue formation.

Dr. Bregman concurs. “They do very well if (decompression is) successful, which is around 85 percent (pain relief). After one year, they have only gotten better, if anything, as far as sensation is concerned, thus reducing risk for ulcer or amputation,” says Dr. Bregman, a Past President of the Association of Extremity Nerve Surgeons.

http://www.podiatrytoday.com/does-nerve-decompression-improve-static-balance-patients-painful-diabetic-neuropathy