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. 2022 Aug 18;10(8):e4478.
doi: 10.1097/GOX.0000000000004478. eCollection 2022 Aug.

Lower Extremity Nerve Decompression for Diabetic Peripheral Neuropathy: A Systematic Review and Meta-analysis

Zahir T Fadel  1 , Wafa M Imran  2 , Turki Azhar  1
Affiliations

Lower Extremity Nerve Decompression for Diabetic Peripheral Neuropathy: A Systematic Review and Meta-analysis

Zahir T Fadel et al. Plast Reconstr Surg Glob Open. .

Abstract

Background: Diabetic peripheral neuropathy (DPN) is a leading cause of morbidity. This systematic review and meta-analysis evaluate the efficacy of lower extremity nerve decompression in reducing DPN symptoms and complications.

Methods: A database search was performed using Medline, Embase, Google Scholar, and Cochrane Central Register of Controlled Trials. Articles addressing surgical decompression of lower limb peripheral nerves in patients with diabetes were screened for inclusion. Two independent reviewers undertook the assessment. Methodological quality measures were the Cochrane risk of bias and Newcastle-Ottawa scale.

Results: The pooled sample size from 21 studies was 2169 patients. Meta-analysis of 16 observational studies showed significant improvement in the visual analog scale (VAS) (P < 0.00001) and two-point discrimination (P = 0.003), with strong reliability. Decompression of the tarsal tunnel region had the highest improvement in VAS [MD, 6.50 (95% CI, 3.56-9.44)]. A significant low-risk ratio (RR) of ulcer development and lower limb amputation was detected (P < 0.00001). Lowest RR of ulcer development was detected with tarsal tunnel release [RR, 0.04 (95% CI, 0.00-0.48)]. Improvements in VAS, two-point discrimination, and nerve conduction velocity were nonsignificant in the meta-analysis of five randomized controlled trials (RCTs). The RCT analysis was limited to only two studies for each outcome.

Conclusions: Meta-analysis of observational studies highlights the efficacy of lower extremity nerve decompression in reducing DPN symptoms, ulcerations, and amputations. Releasing the tibial nerve in the tarsal tunnel region was the most effective observed procedure. Nevertheless, high-quality RCTs are required to support the utility of this intervention in DPN.

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Figures

Fig. 1.
Fig. 1.
Study flow diagram.
Fig. 2.
Fig. 2.
Risk of bias graph: authors’ judgments of included randomized controlled trials using the Cochrane risk-of-bias tool.
Fig. 3.
Fig. 3.
Risk of bias graph: authors’ judgments of included observational studies using the NOS.
Fig. 4.
Fig. 4.
Funnel plots demonstrating no proof of publication bias in RCTs for the analyzed outcomes. A, VAS. B, 2PD. C, NCV.
Fig. 5.
Fig. 5.
Funnel plots: demonstrating no proof of publication bias in observational studies for the analyzed outcomes. A‚ VAS. B‚ 2PD. C‚ Ulcer development. D, Amputation.
Fig. 6.
Fig. 6.
Forest plots of pooled analysis of outcomes in RCTs. A, VAS. B, 2PD. C, NCV.
Fig. 7.
Fig. 7.
Forest plots of pooled analysis of outcomes in observational studies. A, VAS. B, 2PD. C, Ulcer development. D, Amputation.
See this image and copyright information in PMC

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