Decompressive surgery for treating nerve damage in leprosy. A Cochrane review.
OBJECTIVE
Decompressive surgery is used for treating nerve damage in leprosy. We assessed the effectiveness of decompressive surgery for patients with nerve damage due to leprosy.


METHODS
A broad search strategy was performed to find eligible studies, selecting randomised controlled trials (RCTs) comparing decompressive surgery alone or plus corticosteroids with corticosteroids alone, placebo or no treatment. Two authors independently assessed quality and extracted data. Where it was not possible to perform a meta-analysis, the data for each trial was summarised.


RESULTS
We included two randomised controlled trials involving 88 people. The trials examined the added benefit of surgery over prednisolone for treatment of nerve damage of less than 6 months duration. After 2 years follow-up there was no significant difference in nerve function improvement between people treated with surgery plus prednisolone or with prednisolone alone. Adverse effects of decompression surgery were not adequately described.


CONCLUSIONS
Evidence from randomised controlled trials does not show a significant added benefit of surgery over steroid treatment alone. Well-designed randomised controlled trials are needed to establish the effectiveness of the combination of surgery and medical treatment compared to medical treatment alone.
Van Veen
Natasja H J
NH
Department of Public Health, Erasmus MC, University Medical Center Rotterdam, The Netherlands. n.vanveen@erasmusmc.nl
Schreuders
Ton A R
TA
Theuvenet
Willem J
WJ
Agrawal
Amit
A
Richardus
Jan Hendrik
JH
D019299:Decompression, Surgical / Q000009:adverse effects*; D005938:Glucocorticoids / Q000627:therapeutic use; D006801:Humans; D007918:Leprosy / Q000150:complications*; D009408:Nerve Compression Syndromes / Q000188:drug therapy / Q000601:surgery*; D010523:Peripheral Nervous System Diseases / Q000188:drug therapy / Q000209:etiology* / Q000601:surgery; D011239:Prednisolone / Q000627:therapeutic use; D016032:Randomized Controlled Trials as Topic; D016896:Treatment Outcome
D005938:Glucocorticoids; D011239:Prednisolone