In my career, I have seen dramatic changes in the approach to patients that suffer from peripheral neuropathy. When I first began treating patients, I recited the information given to me by my teachers which essentially was: "You're neuropathy is untreatable. There is nothing that you can do to help but other than try and control those disease processes which may be contributing to the problem. If you are diabetic, try and control your blood sugar better, try and get a little exercise, take medication for the pain if needed."
Our Approach to Treating Neuropathy is Optimistic!
Currently, 20 some years later, my approach to neuropathy is much more optimistic. We currently use many treatments both nutritional, pharmaceutical, electrical, chemical, and even surgical to treat this condition. This article is going to discuss the history and effectiveness of nerve decompression surgery in patients with neuropathy.
In patients with diabetic neuropathy, is well documented and easily verified fact that there nerves are much larger than patients without neuropathy in general. The cross-sectional diameter of neuropathic diabetic patients are measured by ultrasound as demonstrated fairly consistent increase in size of the nerves 25-50%. If the nerve is traveling through a restricted area, this increase in size can result in construction of the nerve and increased symptoms of numbness. It's very much like falling asleep with your elbow in the wrong position and waking up with a numb hand. Many researchers believe that roughly 30-60% of patients with diabetes suffering from neuropathy have a component of peripheral nerve compression.
In 1992 a new paradigm was introduced into the treatment of diabetic related neuropathy. A surgeon named A. Lee Dellon noticed that when patients with diabetes with numbness and tingling in their hands improved after carpal tunnel surgery, they would ask him to do the same thing for their feet. He began thinking that perhaps peripheral nerve compression played some role in loss of sensation and uncomfortable nerve feelings in the feet. To make a long story short, many studies have now been published demonstrating benefits that some patients have from nerve decompression. Not all patients with diabetic neuropathy have peripheral nerve compression as a contributing factor to their symptoms. However, a significant percentage do. Here are some of the results of the studies that have been performed examining the benefits of this procedure:
In Shanghai, 560 patients with neuropathy underwent nerve decompression surgery on the lower extremity. Clinical nerve tests for nerve function all showed significant improved. 37 (208 patients) percent of the patients had an ulcer at the time of the surgery and all of them healed by 18 months after surgery (presumably because the patients could now feel their feet). In 2013 the paper was published reviewing articles from many different sources found that observational data suggest that neurolysis significantly improved outcomes for diabetic patients with compressed nerves of the lower extremity. 91% of the patients reported significant decrease in pain and 69% of the patients reported significant increase in ability to feel their feet. Amputation rates were also significantly reduced. NO ULCER = NO AMPUTATION.
Who can benefit from this type of surgery?
Certainly, not all patients that have diabetes and neuropathy have superimposed nerve compression. However, about 30-60% of patients do have compression as a component of their nerve pathology. Interestingly, patients with other forms of "neuropathy" also can respond to this treatment if the criteria for nerve compression is met. Many of these patients, if properly selected and surgery is properly performed, can benefit greatly from nerve decompression surgery.
What are the benefits?
The benefits, according to the studies, include pain relief, increase balance, decreased incidence of ulceration, limb preservation, and increased quality of life.
What we do:
As I stated in the beginning of this article, our clinic uses many different treatments for neuropathy. The use of surgical nerve decompression is only one tool. We have found that this surgery can be extremely helpful to those patients that meet the criteria. We have also found that other therapies can be very effective. Sometimes, multiple treatments including nutrition, physical therapy, nerve decompression surgery, and pharmaceutical treatments are used on the same patient. Certainly we also encourage our patients to control their blood sugar!
If you or someone you know is suffering from neuropathy, contact our Universal City or Pleasanton office today. There is hope!