Decompression of peripheral nerve trunks in leprosy to prevent the development and progression of deformities

Abstract

Background:Peripheral nerve involvement results in deformities in leprosy. High doses (40-60 mg) of steroids along with anti-leprosy drugs is the preferred treatment, even though 70-75% cases still develop deformity. Early surgical decompression of nerves gives better chances of preventing deformity. We have analyzed the role of early surgical decompression in such cases.Materials and Methods:Five hundred nerves (386 ulnar, 60 median and 54 posterior tibial) not responding to the medical treatment in 12 weeks, were undertaken for external and internal nerve trunk decompression. These cases were followed up for five to 20 years at various intervals.Results:The pain in nerve (neuralgia) recovered in all cases of ulnar, median and posterior tibial nerves. Full sensory recovery to pinprick and feather or cotton wool touch was seen in 50% cases of all the three nerves. Twenty percent cases maintained the preoperative levels of sensory status. Plantar ulcers healed within six months after decompression of posterior tibial nerve but six cases showed recurrence. Overall motor recovery in ulnar nerve was 89% and 70% in median nerve.Conclusions:The sensory recovery restores protective sensation which prevents secondary injuries. The improvement of motor power gives better function and improves the appearance, which in the absence of surgical intervention was not possible.

Pure neuritic leprosy presenting as ulnar nerve neuropathy: a case report of electrodiagnostic, radiographic, and histopathological findings

“…12,21 As previously noted, leprosy typically involves major nerves at and above areas associated with compressive neuropathy. Relative compression of the nerves in their fibro-osseous tunnels can be demonstrated by imaging studies and at surgery.…”

“…External decompression and epineurotomy have been used in an effort to improve overall outcomes in patients with leprosy. 12 We decompressed the ulnar nerve at the time of biopsy in our case to alleviate any contribution of compression to his deficit, to prevent potential worsening compression in the face of swelling related to the biopsy, and to theoretically maximize his neural regeneration. 14,25 We believed that the small added morbidity in this case was justified given the typically poor prognosis seen with severe ulnar palsy at the arm level.…”

Modified simple decompression in the treatment of cubital tunnel syndrome: avoiding ulnar nerve subluxation

“…There was no mention of either pre-or postoperative ulnar nerve subluxation in that study, though. Pain relief was observed in all patients, whereas sensory and motor functions improved to normal levels in approximately half of the patients, after external and internal neurolysis, together with medial epicondilectomy in selected cases 8 . Our results demonstrated a similar pain relief, together with improvement by two grades in 40% of the patients on both functional scales, after simple nerve decompression.…”

“…The best evidence available, however, does not support such an approach, since there is no difference in outcome between simple decompression or subcutaneous transposition in cases of intraoperative ulnar nerve instability 10 . Regarding leprosy-associated CuTS, Husain 8 published the largest study involving 772 patients who were unresponsive to corticosteroid treatment. There was no mention of either pre-or postoperative ulnar nerve subluxation in that study, though.…”

“…In Brazil, about 79% of leprosy patients have ulnar nerve impairment 6 , which is related to nerve thickening as a result of the inflammatory process triggered by the intraneural invasion of M. leprae or its antigens; this, in turn, increases the risk of CuTS 7,8 . Cubital tunnel syndrome is mostly treated clinically, but surgical treatment is recommended for patients who are progressively symptomatic and do not show clinical and electrophysiological improvement after weeks of conservative management 1 .…”