Abstract
Background
Symmetrical peripheral neuropathy is a common complication of diabetic neuropathy. No treatments are known to be effective for progressive pain and sensory loss associated with diabetic neuropathy. Alternative effective treatment strategies have been sought.
Objectives
To systematically review the evidence from randomized controlled trials concerning the role of decompressive surgery of lower limbs for symmetrical diabetic peripheral neuropathy.
Search methods
We searched the Cochrane Neuromuscular Disease Trials Register (May 2006), CENTRAL (The Cochrane Library, Issue 2 2006), MEDLINE from (January 1966 to August 2006), EMBASE (from January 1980 to August 2006), LILACS (from January 1982 to August 2006), and CINAHL (from January 1982 to August 2006).
Selection criteria
We included all randomized or quasi-randomized controlled human trials in which any form of decompressive surgery of the lower limbs nerves had been used to treat diabetic symmetrical distal polyneuropathy (DSDP) compared with no treatment or medical therapy. Patients with DSDP were included if they had decompression (with or without neurolysis) of at least two of the following nerves in both lower limbs, for the treatment of DSDP: the posterior tibial nerve (including calcaneal, medial and lateral plantar nerves), deep peroneal nerve at the ankle, common peroneal nerve at the knee, lateral femoral cutaneous nerve and sural nerves in the posterior calf region. The primary outcome measure was the change in pain measured by the visual analogue scale (VAS) between the baseline and a follow-up period of greater than three months.
Data collection and analysis
We identified 142 publications from the above search strategies. The three authors of this manuscript reviewed abstracts of all papers independently. Only eight of these were considered relevant to the question at hand. The data from these 8 studies were entered onto standardized data extraction forms. We planned to use Review Manager to pool the results from appropriate studies comparing the same treatments; dichotomous outcomes to obtain pooled relative risks (RR); measured outcomes to obtain pooled weighted mean differences; and a fixed-effect analysis unless there was evidence of serious heterogeneity between studies sufficient to justify the use of random-effects analysis.
Main results
This review failed to identify a single randomized controlled trial or any other well designed prospective study controlling for the non-operated limb that showed improvements in pre defined end points after decompressive surgery.
Authors’ conclusions
The results of this review suggest that the role of decompressive surgery for diabetic symmetric distal neuropathy is unproven.
Plain language summary
Lower limb surgery to release trapped nerves in diabetic neuropathy
This review analyzed the role of decompressive surgery of lower limb nerves for symmetrical diabetic peripheral neuropathy. Peripheral neuropathy is one of the most common complications of diabetes. Pain and numbness in the feet are common features. Pain may impair the quality of life and lack of feeling puts the diabetic foot at increased risk of ulceration. Strict glucose control may reduce the risk of developing diabetic neuropathy but once developed, neuropathy is irreversible and slowly progressive. New treatment strategies are needed to treat diabetic neuropathy. In this review, the role of surgical decompression of “entrapped” peripheral nerves as an alternative approach to treatment for diabetic neuropathy was analyzed.
