Surgical Management of Painful Diabetic Peripheral Neuropathy: A Focused Review

Peripheral diabeticneuropathy (PDN) is one of the major complications arising in patients with diabetes.A triad of metabolic abnormalities is known that render the peripheral nerve in diabetes mellitus susceptible to chronic compression: conversion of glucose to sorbitol increases the intraneural water content, slowing of axoplasmic transport of proteins hinders structural repair, glycosylation of endoneurial collagen reduces perineurial gliding. Due to connective tissue fibrosis, impaired microcirculation, and impaired endoneurial oxygenation, diabetic peripheral nerves are more at risk for entrapment neuropathies both focally and diffusely.Surgical release and decompression was shown to be effective in many entrapment neuropathies but not in diabetes, hence there is a dearth need to evaluate the current evidence on surgical decompression’s effectiveness in diabetic peripheral neuropathy (DPN). The objective of this review is to provide and evidence-informed update on the effects, efficacy and effectiveness of surgical treatments in patients with painful diabetic peripheral neuropathy (PDPN). MEDLINE was searched for articles and 23 studies were obtained and a descriptive review found that surgical decompression of superimposed nerve compressions in the patient with symptomatic neuropathy reliably relieves pain, restores sensation, and thereby prevents ulceration and amputation. Surgical decompression is thus an established critical, practical and a successful treatment option for patients with PDPN.