Optimization of surgical outcome in lower extremity nerve decompression surgery.

Background: There is still debate whether the surgical release of entrapped lower extremity nerves reduces complaints of associated neuropathy and results in gain of sensory function. The aim of this study is to investigate which factors are associated with a favorable surgical outcome, by follow-up of patients previously participating in a randomized controlled trial. Methods: We evaluated the 5-years follow-up of diabetic patients previously participating in the Lower Extremity Nerve entrapment Study (LENS). Visual Analogue Pain scores, satisfaction, complaints, quality of life (QoL, SF-36 and EQ-5D), sensory function and incident ulceration and amputations were assessed. Differences between patients who underwent unilateral versus bilateral decompressions were investigated. Results: 31 of the original 42 LENS study participants were measured, of which eight patients underwent additional decompression of the contralateral leg, after 12 months LENS follow-up. At 5-years, bilateral operated patients (n=8) had significantly lower pain scores and higher QoL compared to unilateral operated patients (n=23), were younger, had a lower age when diagnosed with diabetes and a lower body mass index (BMI) at baseline. Pain scores of the additional decompressed leg decreased similarly as the initial decompressed leg, during follow-up. Patients with severe pre-operative sensory loss did worse. 41.2% of the LENS-FU subjects underwent or considers having contralateral surgery. Conclusions: Our results suggest that the beneficial effects of lower extremity nerve decompression surgery are reserved for a select group of patients, of which pre-operative nerve damage, age, duration of diabetes and BMI are important effect modifiers. (C)2017American Society of Plastic Surgeons