Comparison between Results of Surgical and Conservative Treatment for Diabetic Peripheral Neuropathy

Background: Diabetic Peripheral Neuropathy (DPN) is a common complication of diabetes. Population-based cohort studies have shown that 66% of type I and 59% of type 2 diabetics have objective evidence of peripheral neuropathy. Complications of DPN are a major cause for hospitalization among people with diabetes, and neuropathy ranks third in lifetime expenditures associated with the complications of diabetes, behind macrovascular disease and nephropathy. Although this hypothesis has some experimental support, evidence to the contrary showing resistance to axonal degeneration after nerve compression also exists. Surgical decompression of multiple peripheral nerves is being utilized as an alternative approach to treatment of symptomatic diabetic neuropathy. This is based on the hypothesis that diabetic nerves are more vulnerable to compressive injury at potential sites for entrapment.Objective: To compare the results of surgical decompression in patients with complicated diabetic peripheral neuropathy with the results of conservative medical treatment.Methods: This study was conducted in the Neurosurgery Department, Faculty of Medicine, Cairo University Hospitals in the period from Decembe 2011 to November 2013. The study included two groups: Group 1: Fifty patients with complicated diabetic peripheral neuropathy who are surgically managed by peripheral nerve decompression in the region of the carpal and tarsal tunnels and Group 2: Fifty patients with complicated diabetic peripheral neuropathy who are treated with conservative medical treatment. All patients were subjected to: Full history taking, complete general medical examination, fasting blood sugar, postprandial blood sugar and electromyography. Surgical candidates were subjected to division of the flexor retinaculum in the hand or feet. Non-surgical candidates were subjected to conservative medical treatment and follow-up.Results: The patients age ranged from 35-75 years for Group I and from 35-72 years for Group II. The mean age was 58.5±10.3 years for Group I and was 57±8.8 years for Group II. There is a good clinical improvement of 80% of cases by surgical decompression of peripheral nerves. 62% of cases show persistent complaints with conservative medical treatment. There is an improvement in nerve conduction velocity after decompression of affected peripheral nerves in 84% of patients of the surgical group. The improvement was 80% in surgical group compared to 38% in medical group and the difference was statistically highly significant. About 73% of the surgically managed patients showed improvement of ischemia in the periphery as well as about 82% showed improvement of the neurologic condition as regarding neuropathic pain and muscle weakness improvement in the form of improved hand-grip and good walking.Conclusions: It could be concluded that patients with complicated Diabetic Peripheral Neuropathy (DPN) could be surgically managed successfully by decompression of peripheral nerves at site of compression in carpal and tarsal tunnels with good results in patients resistant to medical treatment.