Neurologists Issue Guideline for Surgical Decompression to Treat Diabetic Neuropathy

The American Academy of Neurology (AAN) recently issued a practice advisory for clinicians and patients about the use of "surgical decompression" or "decompressive surgery" to treat diabetic neuropathy.

After reviewing the available medical research studies involving surgical decompression, the AAN concluded that based on current knowledge, "the benefits of the surgery are considered unproven", and that "more research is needed to determine the potential benefits or harms."

Diabetic neuropathy, or nerve damage caused by diabetes, is one of the most common causes of neuropathy, with almost 60 percent of diabetics developing some form of nerve damage. Loss of feeling in the feet, a common symptom of diabetic neuropathy, increases the risk of a patient with diabetes developing ulcers or infections. Diabetic neuropathy is usually treated with diet and medication, and by paying extra attention to the feet. Pain, burning and tingling can often be lessened with drugs such as Lyrica and Cymbalta.

Doctors who perform surgical decompression promote the procedure as an alternative way to treat diabetic neuropathy. The theory is that diabetic nerves are more likely to be injured by pressure at sites of anatomical narrowing such as the ankle, foot, or knee. Proponents claim that performing surgery to reduce pressure will restore feeling in the damaged area and reduce pain.

This treatment is controversial, however, because diabetic neuropathy may have many causes in addition to or besides compressive.

In a report developed by the Therapeutics and Technology Subcommittee of the AAN and published as Practice Advisory: Utility of surgical decompression for treatment of diabetic neuropathy, in the June 2006 issue of Neurology, the Subcommittee asked the question, “Is there evidence to support the use of decompressive surgery in the treatment of diabetic neuropathy?”

After reviewing the available medical research literature involving surgical decompression in people with diabetic neuropathy, the Subcommittee had this assessment:

“The current evidence supporting the utility of decompressive surgery for the treatment of diabetic neuropathy is of poor quality and design….None of these studies provided randomization or a control group (other than one weak Class III study which was downgraded to Class IV, in which the patient served as his or her own control). The patients and evaluators were unblinded in 9 of the 10 studies, allowing the opportunity for significant bias in determining outcomes. The definition of peripheral neuropathy in these studies is unclear….

Only a few report the performance of nerve conduction studies, but specific data were not provided….In a majority of the studies, improvement was based on subjective measures and observations of the operating surgeon. Precise description of the location and degree of improvement was not clear in many of these reports. The statistical analyses utilized have nonstandardized measurements.”

The Academy recommends that any person with diabetic neuropathy who is considering this treatment should seek the advice and care of a neurologist and ask the neurologist for more information and services.

Read the Guideline for PATIENTS AND THEIR FAMILIES: SURGICAL DECOMPRESSION FOR TREATMENT OF DIABETIC NEUROPATHY (pdf* file)

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