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Changing the Natural History of Diabetic Neuropathy

A. Lee Dellon, MD, Professor of Plastic Surgery and Neurosurgery, brings us an updated report on the success of using decompression surgery to “change the natural course of diabetic neuropathy”, There are also links at the end of the article to help you find out if decompression surgery would help your patients.

Changing the Natural History of Diabetic Neuropathy
A. Lee Dellon, MD, Professor of Plastic Surgery
and Neurosurgery, Johns Hopkins University, Director of the Dellon Institutes for Peripheral Nerve Surgery http://www.dellonipns.com

The natural history of diabetic neuropathy is well-documented. At the time of diagnosis of diabetes, 12% have a neuropathy , and by 10 years of diabetes, at least 50% of diabetics have neuropathy. Diabetics with neuropathy have a one in 6 chance (15%) of having an ulcer. If you get an ulcer, one in 6 will have an amputation. Half will have an ulcer in the opposite foot within three years. And this may occur even in with a good effort to keep the blood sugar under control. If you loose the feeling in your feet, you lose balance, leading to falls with fractures of the hip or wrist. You cannot feel the pedals of the car to drive. If you have pain with neuropathy, you have increased costs for narcotics and neuropathic pain medication, like gabapentin (Neurontin) and the side effects of these drugs.

What if the symptoms of neuropathy were due to superimposed nerve compressions along the course of the peripheral nerves. A compression of the common peroneal nerve at the fibular head, of the deep peroneal nerve over the dorsum of the foot, and of the tibial nerve and its branches in the tarsal tunnel will give a stocking distribution to the sensory loss, just like neuropathy.

In a recent issue of the Annals of Plastic Surgery, Drs Azmann, Tassler, and Dellon from Johns Hopkins Hospital in Baltimore, Maryland write of proof that this natural history of diabetic neuropathy can be changed. In a group of 50 patients, identified retrospectively, he had done the above operation on just one leg, a mean of 4.5 years (longest interval 7 years). At follow up, none of these legs had developed an ulcer or had an amputation. In contrast, in the contralateral, opposite leg, where no operation had been done, and in which the blood sugar was the same as in the operated leg, the natural history was what had been expected. Of the 50 patients, 11 developed an ulceration and another 3 required an amputation. The statistical difference between these two legs was different at the p > .001 level. This means this observation would have occurred only once in 1000 times.

The article concludes that decompression of multiple peripheral nerves in a leg results in improvement in sensation that prevents ulcers and prevents amputations, effectively changing the natural history of diabetic neuropathy.

More about this surgical procedure can be obtained at DellonIPNS.com and statistics from a prospective multicenter study can be obtained at NeuropathyRegistry.com by clicking on “statistics”.

The exact reference for the article is:
Aszmann OC, Tassler PL, Dellon AL: Changing the natural history of diabetic neuropathy: Incidence of ulcer/amputation in the contralateral limb of patients with a unilateral nerve decompression procedure, accepted Ann Plast Surg, 53:517-522, 2004.
A. Lee Dellon, M.D. is the founder of The Dellon Institutes for Peripheral Nerve Surgery®. He is an accomplished Plastic Surgeon as well as a Professor of Plastic Surgery and Neurosurgery at the prestigious Johns Hopkins University School of Medicine, at the University of Maryland in Baltimore, Maryland and at the University of Arizona, Tucson, Arizona.
He specializes in the treatment of diabetic neuropathy as well as other painful peripheral nerve disorders and has trained many surgeons worldwide in the procedures he has developed to relieve pain.
Dr. Dellon completed his BS at John Hopkins University and received hi Medical Degree from Johns Hopkins University School of Medicine in 1970. He Completed General Surgery, Plastic Surgery and Hand Surgery Residencies at Columbia Presbyterian Hospital, John Hopkins Hospital and Union Memorial Hospital respectively. He has been in practice since 1978 and has been on the faculty of Johns Hopkins since that time.