title: The Positive Effect of Neurolysis on Diabetic Patients with Compressed Nerves of the Lower Extremities: A Systematic Review and Meta-analysis.
abstract: BACKGROUND
  Despite proven benefits of upper extremity nerve decompression in diabetics, neurolysis for diabetic patients with lower extremity (LE) nerve compression remains controversial.
  
  
  METHODS
  A search of ClinicalTrials.gov and Cochrane clinical trials registries, CENTRAL (The Cochrane Library), MEDLINE, EMBASE, LILACS, CINAHL, SCOPUS, and Google Scholar from 1962 to 2012, yielded 1956 citations. Any potential randomized or quasi-randomized controlled trials and observational cohort studies of diabetics with neurolysis of the common peroneal nerve, deep peroneal nerve, or tibial nerve were assessed. We included articles in any language that 1) provided information about diabetic patients who had neurolysis for symptomatic nerve compression diagnosed by (+) Tinel sign or electrodiagnostic study, and 2) quantified outcomes for pain, sensibility, or ulcerations/amputations. Case reports, review articles, animal or cadaver studies, and studies with <10 patients were excluded. We assessed pain relief, recovery of sensibility, and postoperative incidence of ulcerations/amputations at follow-up >3 months. A meta-analysis of descriptive statistics was performed.
  
  
  RESULTS
  Ten clinical series with a mean clinical relevance score of 70% and a mean methodologic quality score of 50% met inclusion criteria. We included 875 diabetic patients and 1053 LEs. Pain relief >3 points on visual analog scale occurred in 91% of patients; sensibility improved in 69%. Postoperative ulceration/amputation incidence was significantly reduced compared to preoperative incidence (odds ratio = 0.066, 95% confidence interval = 0.026-0.164, P < 0.0001).
  
  
  CONCLUSIONS
  Observational data suggest that neurolysis significantly improves outcomes for diabetic patients with compressed nerves of the LE. No randomized controlled trials have been published.
authors.affiliation: Department of Plastic and Reconstructive Surgery, The Johns Hopkins University School of Medicine, Baltimore, Md.; and William H. Welch Medical Library, The Johns Hopkins University School of Medicine, Baltimore, Md.
authors.forename: Pablo A
authors.initials: PA
authors.lastname: Baltodano
authors.affiliation: Department of Plastic and Reconstructive Surgery, The Johns Hopkins University School of Medicine, Baltimore, Md.; and William H. Welch Medical Library, The Johns Hopkins University School of Medicine, Baltimore, Md.
authors.forename: Basak
authors.initials: B
authors.lastname: Basdag
authors.affiliation: Department of Plastic and Reconstructive Surgery, The Johns Hopkins University School of Medicine, Baltimore, Md.; and William H. Welch Medical Library, The Johns Hopkins University School of Medicine, Baltimore, Md.
authors.forename: Christopher R
authors.initials: CR
authors.lastname: Bailey
authors.affiliation: Department of Plastic and Reconstructive Surgery, The Johns Hopkins University School of Medicine, Baltimore, Md.; and William H. Welch Medical Library, The Johns Hopkins University School of Medicine, Baltimore, Md.
authors.forename: Marcelo J Lacayo
authors.initials: MJ
authors.lastname: Baez
authors.affiliation: Department of Plastic and Reconstructive Surgery, The Johns Hopkins University School of Medicine, Baltimore, Md.; and William H. Welch Medical Library, The Johns Hopkins University School of Medicine, Baltimore, Md.
authors.forename: Anne
authors.initials: A
authors.lastname: Tong
authors.affiliation: Department of Plastic and Reconstructive Surgery, The Johns Hopkins University School of Medicine, Baltimore, Md.; and William H. Welch Medical Library, The Johns Hopkins University School of Medicine, Baltimore, Md.
authors.forename: Stella M
authors.initials: SM
authors.lastname: Seal
authors.affiliation: Department of Plastic and Reconstructive Surgery, The Johns Hopkins University School of Medicine, Baltimore, Md.; and William H. Welch Medical Library, The Johns Hopkins University School of Medicine, Baltimore, Md.
authors.forename: Mark M
authors.initials: MM
authors.lastname: Meléndez
authors.affiliation: Department of Plastic and Reconstructive Surgery, The Johns Hopkins University School of Medicine, Baltimore, Md.; and William H. Welch Medical Library, The Johns Hopkins University School of Medicine, Baltimore, Md.
authors.forename: Li
authors.initials: L
authors.lastname: Xie
authors.affiliation: Department of Plastic and Reconstructive Surgery, The Johns Hopkins University School of Medicine, Baltimore, Md.; and William H. Welch Medical Library, The Johns Hopkins University School of Medicine, Baltimore, Md.
authors.forename: Michele A
authors.initials: MA
authors.lastname: Manahan
authors.affiliation: Department of Plastic and Reconstructive Surgery, The Johns Hopkins University School of Medicine, Baltimore, Md.; and William H. Welch Medical Library, The Johns Hopkins University School of Medicine, Baltimore, Md.
authors.forename: Gedge D
authors.initials: GD
authors.lastname: Rosson