The Surgical Treatment of Cubital Tunnel Syndrome: A Decision Analysis

Abstract

The objective of our study was to use decision analysis to compare four common surgical treatments for cubital tunnel syndrome: simple decompression of the cubital tunnel, medial epicondylectomy, anterior subcutaneous transposition and anterior submuscular transposition. The variables used for this decision analysis model were based on data from the literature. Extensive sensitivity analyses were carried out to test the impact of the values given to these variables on the outcome of the model. The highest expected utility, 0.973, was associated with simple decompression. The expected utility was 0.969 for subcutaneous transposition and 0.965 for submuscular transposition. Medial epicondylectomy had the lowest expected utility at 0.961. Simple decompression remained the preferred strategy in extensive one-way sensitivity analyses.

Outcomes Measures Used to Assess Results After Surgery for Cubital Tunnel Syndrome: A Systematic Review of the Literature

“…One study examined utility scores for each procedure. 20 Overall, simple decompression was found to have the highest utility, and a cost analysis study also found it to be less expensive than subcutaneous transposition. 16 …”

Patient-Rated Outcome of Ulnar Nerve Decompression: A Comparison of Endoscopic and Open In Situ Decompression

“…4,5 This is supported by a detailed decision analysis model that favors in situ decompression. 21 With the acceptance of in situ decompression as an effective treatment for cubital tunnel syndrome, methods for minimally invasive 22 and endoscopic-assisted ulnar nerve decompression have been investigated. A technique for endoscopic in situ decompression was first described by Tsai et al 9 Subsequently, alternative techniques have been described, 7,8,10,23 with supporting anatomic studies.…”

Surgical Options for Ulnar Nerve Entrapment: An Example of Individualized Decision Analysis

“…The only clinical decision-analysis study with a reliable design recommends simple decompression as the preferred surgical treatment for moderate-to-severe cubital tunnel syndrome, with submuscular transposition as a salvage procedure if sensory symptoms are not resolved [5]. Some assumptions are necessary for the creation of such study, based on probability of occurrences of both the utilities (favorable advantages) and the disutilities (complications or inconveniences) of the different procedures.…”