Rationale, Science, and Economics of Surgical Nerve Decompression for Diabetic Neuropathy Foot Complications

Published:January 30, 2016DOI:https://doi.org/10.1016/j.cpm.2015.12.004

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      References

        • Halawa M.R.
        • Karawagh A.
        • Zeidan A.
        • et al.
        Prevalence of painful diabetic peripheral neuropathy among patients suffering from diabetes mellitus in Saudi Arabia.
        Curr Med Res Opin. 2010; 26: 337-343
        • Salvotelli L.
        • Stoico V.
        • Perrone F.
        • et al.
        Prevalence of neuropathy in type 2 diabetic patients and its association with other diabetes complications: The Verona Diabetic Foot Screening Program.
        J Diabetes Complications. 2015; 29: 1066-1070
        • Lavery L.A.
        • La Fontaine J.
        • Kim P.J.
        Preventing the first or recurrent ulcers.
        Med Clin North Am. 2013; 97: 807-820
        • Lavery L.A.
        • Armstrong D.G.
        • Wunderlich R.P.
        • et al.
        Risk factors for foot infections in individuals with diabetes.
        Diabetes Care. 2006; 29: 1288-1293
        • Armstrong D.G.
        • Lavery L.A.
        Diabetic foot ulcers: prevention, diagnosis and classification.
        Am Fam Physician. 1998; 57 (1337–8): 1325-1332
        • Iversen M.M.
        • Tell G.S.
        • Riise T.
        • et al.
        History of foot ulcer increases mortality among individuals with diabetes: ten-year follow-up of the Nord-Trøndelag Health Study, Norway.
        Diabetes Care. 2009; 32: 2193-2199
        • American Diabetes Association
        Economic costs of diabetes in the U.S. in 2012.
        Diabetes Care. 2013; 36: 1033-1046
        • Singh N.
        • Armstrong D.G.
        • Lipsky B.A.
        Preventing foot ulcers in patients with diabetes.
        JAMA. 2005; 293: 217-228
        • Morbach S.
        • Furchert H.
        • Groblinghoff U.
        • et al.
        Long-term prognosis of diabetic foot patients and their limbs: amputation and death over the course of a decade.
        Diabetes Care. 2012; 35: 2021-2027
        • Bongaerts B.W.
        • Rathmann W.
        • Heier M.
        • et al.
        Older subjects with diabetes and prediabetes are frequently unaware of having distal sensorimotor polyneuropathy: the KORA F4 study.
        Diabetes Care. 2013; 36: 1141-1146
        • Wukich D.K.
        • Crim B.E.
        • Frykberg R.G.
        • et al.
        Neuropathy and poorly controlled diabetes increase the rate of surgical site infection after foot and ankle surgery.
        J Bone Joint Surg Am. 2014; 96: 832-839
        • Wukich D.K.
        • McMillen R.L.
        • Lowery N.J.
        • et al.
        Surgical site infections after foot and ankle surgery: a comparison of patients with and without diabetes.
        Diabetes Care. 2011; 34: 2211-2213
        • Armstrong D.G.
        • Lavery L.A.
        • Stern S.
        • et al.
        Is prophylactic diabetic foot surgery dangerous?.
        J Foot Ankle Surg. 1996; 35: 585-589
        • Wukich D.K.
        • Lowery N.J.
        • McMillen R.L.
        • et al.
        Postoperative infection rates in foot and ankle surgery: a comparison of patients with and without diabetes mellitus.
        J Bone Joint Surg Am. 2010; 92: 287-295
        • Martins-Mendes D.
        • Monteiro-Soares M.
        • Boyko E.J.
        • et al.
        The independent contribution of diabetic foot ulcer on lower extremity amputation and mortality risk.
        J Diabetes Complications. 2014; 28: 632-638
        • Pound N.
        • Chipchase S.
        • Treece K.
        • et al.
        Ulcer-free survival following management of foot ulcers in diabetes.
        Diabet Med. 2005; 22: 1306-1309
        • Won S.H.
        • Chung C.Y.
        • Park M.S.
        • et al.
        Risk factors associated with amputation-free survival in patient with diabetic foot ulcers.
        Yonsei Med J. 2014; 55: 1373-1378
        • Driver V.R.
        • Fabbi M.
        • Lavery L.A.
        • et al.
        The costs of diabetic foot: the economic case for the limb salvage team.
        J Am Podiatr Med Assoc. 2010; 100: 335-341
        • Rice J.B.
        • Desai U.
        • Cummings A.K.
        • et al.
        Burden of diabetic foot ulcers for Medicare and private insurers.
        Diabetes Care. 2014; 37: 651-658
        • Skrepnek G.H.
        • Armstrong D.G.
        • Mills J.L.
        Open bypass and endovascular procedures among diabetic foot ulcer cases in the United States from 2001 to 2010.
        J Vasc Surg. 2014; 60: 1255-1264
        • Vinik A.
        • Mehrabyan A.
        • Colen L.
        • et al.
        Focal entrapment neuropathies in diabetes.
        Diabetes Care. 2004; 27: 1783-1788
        • Sessions J.
        • Nickerson D.S.
        Biologic basis of nerve decompression surgery for focal entrapments in diabetic peripheral neuropathy.
        J Diabetes Sci Technol. 2014; 8: 412-418
        • Thorpe S.R.
        • Baynes J.W.
        Role of the Maillard reaction in diabetes mellitus and diseases of aging.
        Drugs Aging. 1996; 9: 69-77
        • Shar Hashemi S.
        • Cheikh I.
        • Lee Dellon A.
        Prevalence of upper and lower extremity Tinel signs in diabetics: cross-sectional study from a United States, urban hospital-based population.
        J Diabetes Metab. 2013; 4: 2
        • Dellon A.L.
        Diabetic neuropathy: medical and surgical approaches.
        Clin Podiatr Med Surg. 2007; 24 (viii): 425-448
        • Dellon A.L.
        Treatment of symptomatic diabetic neuropathy by surgical decompression of multiple peripheral nerves.
        Plast Reconstr Surg. 1992; 89 ([discussion: 698–9]): 689-697
        • Nickerson D.S.
        • Nickerson D.E.
        A review of therapeutic nerve decompression for neuropathy in Hansen's disease with research suggestions.
        J Reconstr Microsurg. 2010; 26: 277-284
        • Dellon A.L.
        • Mackinnon S.E.
        • Seiler 4th, W.A.
        Susceptibility of the diabetic nerve to chronic compression.
        Ann Plast Surg. 1988; 20: 117-119
        • Dellon A.L.
        A cause for optimism in diabetic neuropathy.
        Ann Plast Surg. 1988; 20: 103-105
        • Siemionow M.
        • Sari A.
        • Demir Y.
        Effect of early nerve release on the progression of neuropathy in diabetic rats.
        Ann Plast Surg. 2007; 59: 102-108
        • Dyck P.J.
        • Engelstad J.K.
        • Giannini C.
        • et al.
        Resistance to axonal degeneration after nerve compression in experimental diabetes.
        Proc Natl Acad Sci U S A. 1989; 86: 2103-2106
        • Dyck P.J.
        • Lais A.C.
        • Giannini C.
        • et al.
        Structural alterations of nerve during cuff compression.
        Proc Natl Acad Sci U S A. 1990; 87: 9828-9832
        • Jaramillo J.
        • Simard-Duquesne N.
        • Dvornik D.
        Resistance of the diabetic rat nerve to ischemic inactivation.
        Can J Physiol Pharmacol. 1985; 63: 773-777
        • Gupta R.
        • Rowshan K.
        • Chao T.
        • et al.
        Chronic nerve compression induces local demyelination and remyelination in a rat model of carpal tunnel syndrome.
        Exp Neurol. 2004; 187: 500-508
        • Jung J.
        • Hahn P.
        • Choi B.
        • et al.
        Early surgical decompression restores neurovascular blood flow and ischemic parameters in an in vivo animal model of nerve compression injury.
        J Bone Joint Surg Am. 2014; 96: 897-906
        • Tapadia M.
        • Mozaffar T.
        • Gupta R.
        Compressive neuropathies of the upper extremity: update on pathophysiology, classification, and electrodiagnostic findings.
        J Hand Surg. 2010; 35: 668-677
        • Jung J.
        • Frump D.
        • Su J.
        • et al.
        Desert hedgehog is a mediator of demyelination in compression neuropathies.
        Exp Neurol. 2015; 271: 84-94
        • Pham K.
        • Gupta R.
        Understanding the mechanisms of entrapment neuropathies. Review article.
        Neurosurg Focus. 2009; 26: E7
        • Dahlin L.B.
        Aspects on pathophysiology of nerve entrapments and nerve compression injuries.
        Neurosurg Clin N Am. 1991; 2: 21-29
        • Lee D.
        • Dauphinee D.M.
        Morphological and functional changes in the diabetic peripheral nerve: using diagnostic ultrasound and neurosensory testing to select candidates for nerve decompression.
        J Am Podiatr Med Assoc. 2005; 95: 433-437
        • Riazi S.
        • Bril V.
        • Perkins B.A.
        • et al.
        Can ultrasound of the tibial nerve detect diabetic peripheral neuropathy? A cross-sectional study.
        Diabetes Care. 2012; 35: 2575-2579
        • Zhong W.
        • Zhang W.
        • Yang M.
        • et al.
        Impact of diabetes mellitus duration on effect of lower extremity nerve decompression in 1,526 diabetic peripheral neuropathy patients.
        Acta Neurochir (Wien). 2014; 156: 1329-1333
        • Macaré van Maurik J.F.
        • Schouten M.E.
        • ten Katen I.
        • et al.
        Ultrasound findings after surgical decompression of the tarsal tunnel in patients with painful diabetic polyneuropathy: a prospective randomized study.
        Diabetes Care. 2014; 37: 767-772
        • Thakkar R.S.
        • Del Grande F.
        • Thawait G.K.
        • et al.
        Spectrum of high-resolution MRI findings in diabetic neuropathy.
        AJR Am J Roentgenology. 2012; 199: 407-412
        • Zhang Y.
        • Li J.
        • Wang T.
        • et al.
        Amplitude of sensory nerve action potential in early stage diabetic peripheral neuropathy: an analysis of 500 cases.
        Neural Regen Res. 2014; 9: 1389-1394
        • Zhang W.
        • Zhong W.
        • Yang M.
        • et al.
        Evaluation of the clinical efficacy of multiple lower-extremity nerve decompression in diabetic peripheral neuropathy.
        Br J Neurosurg. 2013; 27: 795-799
        • Baltodano P.A.
        • Basdag B.
        • Bailey C.R.
        • et al.
        The positive effect of neurolysis on diabetic patients with compressed nerves of the lower extremities: a systematic review and meta-analysis.
        Plast Reconstr Surg Glob Open. 2013; 1: e24
        • Dellon A.L.
        The Dellon approach to neurolysis in the neuropathy patient with chronic nerve compression.
        Handchir Mikrochir Plast Chir. 2008; 40: 351-360
        • Valdivia Valdivia J.M.
        • Weinand M.
        • Maloney Jr., C.T.
        • et al.
        Surgical treatment of superimposed, lower extremity, peripheral nerve entrapments with diabetic and idiopathic neuropathy.
        Ann Plast Surg. 2013; 70: 675-679
        • Dellon A.L.
        • Muse V.L.
        • Scott N.D.
        • et al.
        A positive Tinel sign as predictor of pain relief or sensory recovery after decompression of chronic tibial nerve compression in patients with diabetic neuropathy.
        J Reconstr Microsurg. 2012; 28: 235-240
        • Melenhorst W.B.
        • Overgoor M.L.
        • Gonera E.G.
        • et al.
        Nerve decompression surgery as treatment for peripheral diabetic neuropathy: literature overview and awareness among medical professionals.
        Ann Plast Surg. 2009; 63: 217-221
        • Chaudhry V.
        • Russell J.
        • Belzberg A.
        Decompressive surgery of lower limbs for symmetrical diabetic peripheral neuropathy.
        Cochrane Database Syst Rev. 2008; (CD006152)
        • Chaudhry V.
        • Stevens J.C.
        • Kincaid J.
        • et al.
        Practice advisory: utility of surgical decompression for treatment of diabetic neuropathy: report of the therapeutics and technology assessment subcommittee of the American Academy of Neurology.
        Neurology. 2006; 66: 1805-1808
        • Perkins B.A.
        • Olaleye D.
        • Bril V.
        Carpal tunnel syndrome in patients with diabetic polyneuropathy.
        Diabetes Care. 2002; 25: 565-569
        • Cornblath D.R.
        • Vinik A.
        • Feldman E.
        • et al.
        Surgical decompression for diabetic sensorimotor polyneuropathy.
        Diabetes Care. 2007; 30: 421-422
        • Aszmann O.C.
        • Kress K.M.
        • Dellon A.L.
        Results of decompression of peripheral nerves in diabetics: a prospective, blinded study.
        Plast Reconstr Surg. 2000; 106: 816-822
        • Ducic I.
        • Taylor N.S.
        • Dellon A.L.
        Relationship between peripheral nerve decompression and gain of pedal sensibility and balance in patients with peripheral neuropathy.
        Ann Plast Surg. 2006; 56: 145-150
        • Macaré van Maurik J.F.
        • Ter Horst B.
        • van Hal M.
        • et al.
        Effect of surgical decompression of nerves in the lower extremity in patients with painful diabetic polyneuropathy on stability: a randomized controlled trial.
        Clin Rehabil. 2015; 29: 994-1001
        • Macaré van Maurik J.F.
        • van Hal M.
        • van Eijk R.P.
        • et al.
        Value of surgical decompression of compressed nerves in the lower extremity in patients with painful diabetic neuropathy: a randomized controlled trial.
        Plast Reconstr Surg. 2014; 134: 325-332
        • Nickerson D.S.
        • Rader A.J.
        Nerve decompression after diabetic foot ulceration may protect against recurrence: a 3-year controlled, prospective analysis.
        J Am Podiatr Med Assoc. 2014; 104: 66-70
        • Rozen S.
        Level 1 DNND Nerve Study; Reports and Insights. Presented at the Annual Symposium. Association of Extremity Nerve Surgeons.
        Wimberley, TX, 2015
        • Dellon A.L.
        • Muse V.L.
        • Nickerson D.S.
        • et al.
        Prevention of ulceration, amputation, and reduction of hospitalization: outcomes of a prospective multicenter trial of tibial neurolysis in patients with diabetic neuropathy.
        J Reconstr Microsurg. 2012; 28: 241-246
        • Rosson G.D.
        • Larson A.R.
        • Williams E.H.
        • et al.
        Tibial nerve decompression in patients with tarsal tunnel syndrome: pressures in the tarsal, medial plantar, and lateral plantar tunnels.
        Plast Reconstr Surg. 2009; 124: 1202-1210
        • Aszmann O.
        • Tassler P.L.
        • Dellon A.L.
        Changing the natural history of diabetic neuropathy: incidence of ulcer/amputation in the contralateral limb of patients with a unilateral nerve decompression procedure.
        Ann Plast Surg. 2004; 53: 517-522
        • Nickerson D.S.
        Low recurrence rate of diabetic foot ulcer after nerve decompression.
        J Am Podiatr Med Assoc. 2010; 100: 111-115
        • Nickerson D.S.
        • Rader A.J.
        Low long-term risk of foot ulcer recurrence after nerve decompression in a diabetes neuropathy cohort.
        J Am Podiatr Med Assoc. 2013; 103: 380-386
      1. Barrett S, Levine T, Hank N, et al. A pilot trial of peripheral nerve decompression for painful diabetic neuropathy. 2013; American Academy of Neurology Convention, San Diego, March 16–23, 2013.

        • Todd K.H.
        • Funk K.G.
        • Funk J.P.
        • et al.
        Clinical significance of reported changes in pain severity.
        Ann Emerg Med. 1996; 27: 485-489
        • Farrar J.T.
        • Portenoy R.K.
        • Berlin J.A.
        • et al.
        Defining the clinically important difference in pain outcome measures.
        Pain. 2000; 88: 287-294
        • Garrod K.
        • Scott LaJoie A.
        • McCabe S.
        • et al.
        Prevention of ulceration and amputation, by neurolysis of peripheral nerves in diabetics with neuropathy and nerve compression: decision-tree utility analysis.
        J Diabetes Metab. 2014; 5: 5
        • Rankin T.M.
        • Miller J.D.
        • Gruessner A.C.
        • et al.
        Illustration of cost saving implications of lower extremity nerve decompression to prevent recurrence of diabetic foot ulceration.
        J Diabetes Sci Technol. 2015; 9: 873-880
        • Yudovsky D.
        • Nouvong A.
        • Schomacker K.
        • et al.
        Assessing diabetic foot ulcer development risk with hyperspectral tissue oximetry.
        J Biomed Opt. 2011; 16: 026009
        • Trignano E.
        • Fallico N.
        • Chen H.C.
        • et al.
        Evaluation of peripheral microcirculation improvement of foot after tarsal tunnel release in diabetic patients by transcutaneous oximetry.
        Microsurgery. 2015; ([Epub ahead of print])