12/24/2022 0 Comments Dx 50 decompressor![]() The results of the Markov cost-effectiveness studies are worth further comment. ![]() The two most recent approaches, using the highest form of analysis, Markov analysis, not only confirmed that the cost of surgical decompression is less than the cost of standard medical care for the treatment of diabetic neuropathy, but also proved that surgical decompression of lower extremity nerves improves the quality of life and even prolongs life. There have been two economic cost-benefit analyses using the decision-tree approach that concluded that the cost of surgical decompression is less than the cost of standard medical care for the treatment of diabetic neuropathy. Subsequently, 19 Level IV studies, two systematic reviews, and three Level I studies have all concluded that decompression of lower extremity nerves in diabetics relieves pain, improves sensation, and prevents ulcers and amputations. These studies confirm experimentally the hypothesis I proposed in 1988, that the double crush concept did apply to diabetes clinically: the underlying pathophysiology of diabetes acts as the first crush, or site of compression, making the nerve susceptible to more distal sites of compression. There have been four independent basic science studies that demonstrate that rats with streptozotocin-induced diabetes will not develop a neuropathic walking track pattern, and will have improved lower extremity motor function and improved perception of pain. Relationship in the upper and the lower extremity between the number of nerve compressions in diabetics with and without neuropathy for a given site of nerve entrapment. the expected 3.7% had a hospitalization for foot infection. the expected 15% had an amputation, and 0.6% vs. the expected 15% of patients developed ulceration, 0.2% vs. In 2012, a multicenter prospective study of 38 surgeons, including 800 patients with a 3-year follow-up, demonstrated that 80% of patients had a significant ( P < 0.001) relief of pain by six months after surgery, sensation recovered in the feet, 0.3% vs. Subsequent studies demonstrated that there was significantly less ( P < 0.001) ulceration and amputation for a patient that had nerve decompression than the “control” that did not have that surgery. In 1982, I began doing decompression of lower extremity nerves in diabetics and the results of this work were reported in 1992, demonstrating that 80% of patients with a positive Tinel sign of the tibial nerve in the tarsal tunnel had improved sensation, and decreased pain. About 50% of patients with diabetic neuropathy have multiple chronic lower extremity nerve compressions. Since about 50% of people with diabetes develop neuropathy, the worldwide explosion of diabetes means that there will be an explosion of patients with diabetic neuropathy. The remaining barriers to acceptance and implementation of this proven surgical approach must lie in the education of physicians in training and re-education of diabetes educators, primary care providers and endocrinologists. Furthermore, economic cost-benefit analysis by the Markov technique demonstrates that lower extremity nerve compression is not only cost-effective compared to standard medical care, but also increases the quality of life and life expectancy. ![]() The current evidence is overwhelmingly clear, in diabetics with neuropathy and a positive Tinel sign over the tibial nerve at the tarsal tunnel, that decompression, by neurolysis of lower extremity nerves, can relieve pain, restore sensation, and prevent ulceration and amputation. A review of the history and literature related to the current approach to the patient with chronic nerve compression plus diabetic neuropathy was undertaken. ![]() The aim of this article is to update the reader on the current status of lower extremity nerve decompression in patients with diabetic neuropathy. The loss of sensation in the feet of people with diabetic neuropathy is the primary cause of their ulceration and amputation, as well as pain. Diabetics are well-known to have chronic nerve compressions, and the prevalence of compressions exceeds 50% in those with neuropathy. The number of people with diabetes worldwide has reached epidemic proportions. ![]()
0 Comments
Leave a Reply. |
AuthorWrite something about yourself. No need to be fancy, just an overview. ArchivesCategories |