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Peripheral Nerve Decompression Surgery for Neuropathy

A Revolution in Treatment of Diabetic Neuropathy

When patients struggle with diabetic neuropathy, it's difficult to tell them that their only treatment options are medications that are only moderately effective. Now you don't have to.

Dr. Nathan Lucas of Advanced Foot and Ankle Care of Memphis, TN now offer relief of diabetic neuropathy symptoms through decompression of multiple peripheral nerves. Dr. Lucas was trained by Dr. A. Lee Dellon, a professor of plastic surgery and neurosurgery at Johns Hopkins University, and both physicians are two of only about 100 physicians nationwide trained to perform nerve decompression surgery for diabetic neuropathy.

A New Understanding of Diabetic Neuropathy and Its Treatment - As physicians have long known, uncontrolled diabetes causes nerves to swell. Glucose enters nerves to provide energy and is then converted to another sugar, sorbitol, that attracts water. As sorbitol draws water into nerves, the nerves swell. But the swelling alone does not cause the tingling, numbness and pain common to diabetic neuropathy. Symptoms result when nerves swell in anatomic regions that are already narrow, like the protective tunnels leading to the hands and feet.

Individuals with diabetic neuropathy experience symptoms in a "stocking and glove" pattern, meaning that sensory changes occur on the entire foot or hand. This differs from most other nerve compression syndromes, which produce symptoms in a smaller area - the area served by one nerve. This differing pattern led physicians to believe that symptoms of diabetic neuropathy were not related to nerve compression. In truth, they're caused by the compression of multiple nerves, leading to more widespread sensory problems.

Deaconess Wound Services surgeons now perform nerve decompression surgery to relieve pressure from swollen nerves in patients with diabetes.

Benefits of Surgery - Studies performed between 1992 and 2000 show that, overall, about 80% of patients with diabetic neuropathy experienced improved sensory and motor function, reduced pain, and improved balance after nerve decompression surgery. Equally important, of patients who had sensation restored with the procedure, none developed an ulcer. This indicates that the surgery is actually changing the natural course of disease for many diabetes patients.

Decompression surgery cannot change the metabolic problems that cause nerves to swell, but it can relieve the compression that causes the symptoms of diabetic neuropathy. When performed early in the course of nerve compression, the surgery restores blood flow to nerves, ends symptoms of numbness and tingling, and allows nerves to recover. When treatment is delayed until nerve fibers have begun to die, decompression can facilitate nerve regrowth.

Surgery Candidates - Ideally, surgery is performed in the earlier stages of disease - before all feeling is gone or ulceration develops. Patients who wait too long may experience permanent nerve damage. A history of ulcerations or toe amputation does not necessarily mean that it's too late for surgery. Our surgeons will consider each patient's medical history, symptoms and physical exam findings to determine if nerve decompression surgery may help.

Risks of Surgery - Anesthesia poses the greatest risk in this surgery. Additionally, as with any surgery, there is a risk of bleeding, infection, scar formation and failure of the procedure to achieve the desired goal.

Clinical References

Treatment of Symptomatic Diabetic Neuropathy by Surgical Decompression of Multiple Peripheral Nerves. Dellon, Plast.Reconstr.Surg. 89:689,1992.
Treatment of Hyperesthetic Neuropathic Pain in Diabetics: Decompression of the Tarsal Tunnel. Wieman & Patel, Ann.Surg. 221:660,1995.
Treatment of Diabetic Neuropathy by Decompression of the Posterior Tibial Nerve. Caffee, Plast.Reconstr.Surg. 106:813, 2000.
Results of Decompression of Peripheral Nerves in Diabetics: A Prospective, Blinded Study. Aszmann, Kress, & Dellon, Plast.Reconstr.Surg. 106:816, 2000