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ASPN #2 Neurolysis Outcomes in Leprosy Patients: Prospective Stufy of Sensory and Motor Changes Following "Double CRUSH" Decompressions
Eric Wan, BS; Gedge D Rosson, MD; A. Lee Dellon, MD
Johns Hopkins University, Towson, MD

Purpose: Since the mid-1950s, for "leprosy," retrospective case series reported outcomes following decompression of single anatomic sites of compression, and, more recently studies comparing efficacy of steroid versus single surgical site decompression have been reported. The purpose of the present study is to apply, prospectively, concepts developed from the successful treatment of diabetics with neuropathy and multiple sites of chronic nerve compression to patients with leprous neuropathy.

Methods: Working in the indigenous leprosy area in Guayaquil, Ecuador, a protocol was developed that could be applied prospectively to a cohort of 20 patients with leprous neuropathy who had been medically treated for infection but who had not received steroid treatment for neuropathy. An IRB-approved protocol was established in which each patient received surgery upon one leg and one arm simultaneously, with the goal of decompressing nerves at multiple anatomic sites of known compression, e.g., median and ulnar nerve at the wrist and elbow, peroneal nerve at knee and lower leg, tibial nerve at the four medial ankle tunnels. A total of 88 nerves were decompressed. Outcomes measured were changes in one and two-point static-touch, muscle strength change by manual motor testing and grip strength, comparison between operated and non operated side, and changes in score of validated "instruments" to measure quality of life, disability and pain (Rand36, Q Dash, and VAS, respectively). Outcome measurements were obtained by someone other than the surgeon at 12 and 24 months post-operatively.

Results: Eighteen of 20 patients returned for post-operative sensory evaluation. There were no post-operative complications. 72% of patients have sensory improvement demonstrated by PSSD testing. 65% of patients returned for motor testing, and 100% reported motor improvement and demonstrated motor testing score of > 4/5. 64% of decompressed nerves improved in sensibility: 78% of 18 median nerves, 53% of 17 ulnar nerves, 63% of 16 radial nerves, 71% of 14 common peroneal nerves, and 56% of 16 tibial nerves. Among those patients with completed outcome instruments, quality of life improved, hand disability decreased and pain scores decreased significantly, p < .05.

Conclusions: Application of double crush concept to decompression of multiple peripheral nerves is feasible in the population with leprous neuropathy, and, in this small cohort of patients, gave improvement in sensory and motor function in the majority of patients.

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