Wilson Christopher, Yaacoub Alan P, Bakare Adewale, Bo Na, Aasar Abdul, Barbaro Nicholas M
J Neurosurg Spine. 2019 Feb 8;30(5):714-721. doi: 10.3171/2018.10.SPINE18626. Print 2019 May 1.
A common cause of peroneal neuropathy is compression near the fibular head. Studies demonstrate excellent outcomes after decompression but include few cases (range 15-60 patients). Consequently, attempts to define predictors of good outcomes are limited. Here, the authors combine their institutional outcomes with those in the literature to identify predictors of good outcomes after peroneal nerve decompression.
The authors searched their institutional electronic medical records to identify all peroneal nerve decompressions performed in the period between December 1, 2012, and September 30, 2016, and created an IRB-approved database. They also conducted a MEDLINE and literature search to identify articles discussing surgical decompression. All data were combined by meta-analysis to identify the factors associated with a favorable outcome, which was defined as improvement in preoperative symptoms. Patients were analyzed in the aggregate and by presentation (pain, paresthesias, weakness, foot drop). The factors evaluated included age, sex, body mass index, diabetes, smoking status, previous knee or lumbar spine surgery, preoperative symptom duration, and etiology. A meta-analysis was completed for any factor evaluated in at least three data sets.
Twenty-one institutional cases had sufficient data for review. The follow-up among this group was long: median 29 months, range 12-52 months. On aggregate analysis of the data, only diabetes was significantly associated with unfavorable outcomes after decompression (p = 0.05). A trend toward worse outcomes was seen in smokers presenting with pain (p = 0.06). Outcomes were not affected by presentation.An additional 115 cases in the literature had extractable data for meta-analysis, and other associations were seen. Preoperative symptom duration longer than 12 months was associated with unfavorable outcomes (OR 0.23, 95% CI 0.08-0.65). Patients presenting with paresthesias or hypesthesia demonstrated a trend toward more unfavorable outcomes when operated on more than 6 months after symptom onset (OR 0.37, 95% CI 0.13-1.06). Even after the meta-analysis, outcomes did not vary with an advanced age (OR 0.70, 95% CI 0.24-1.98) or with patient sex (OR 1.13, 95% CI 0.42-3.06).
The authors provide their institutional data in combination with published data regarding outcomes after peroneal nerve decompression. Outcomes are typically favorable and generally unaffected by the type of symptoms preoperatively, especially if the patient is nondiabetic and preoperative symptom duration is less than 12 months. Patients with paresthesias may benefit from surgery within 6 months after onset. Smoking may adversely affect surgical outcomes. Finally, an advanced age does not adversely affect outcomes, and older patients should be considered for surgery.
腓总神经病变的一个常见原因是在腓骨头附近受到压迫。研究表明减压术后效果良好，但所纳入病例较少（范围为15 - 60例患者）。因此，确定良好预后预测因素的尝试受到限制。在此，作者将其机构的治疗结果与文献中的结果相结合，以确定腓总神经减压术后良好预后的预测因素。
作者检索了其机构的电子病历，以确定2012年12月1日至2016年9月30日期间进行的所有腓总神经减压手术，并创建了一个经机构审查委员会批准的数据库。他们还进行了医学文献数据库（MEDLINE）检索和文献搜索，以确定讨论手术减压的文章。所有数据通过荟萃分析进行合并，以确定与良好预后相关的因素，良好预后定义为术前症状改善。对患者进行总体分析，并按症状表现（疼痛、感觉异常、无力、足下垂）进行分析。评估的因素包括年龄、性别、体重指数、糖尿病、吸烟状况、既往膝关节或腰椎手术史、术前症状持续时间和病因。对至少在三个数据集中评估的任何因素进行荟萃分析。
21例机构病例有足够的数据可供审查。该组的随访时间较长：中位数为29个月，范围为12 - 52个月。对数据进行总体分析时，只有糖尿病与减压术后不良预后显著相关（p = 0.05）。出现疼痛的吸烟者预后有变差的趋势（p = 0.06）。预后不受症状表现的影响。文献中另外115例病例有可提取的数据用于荟萃分析，还发现了其他相关性。术前症状持续时间超过12个月与不良预后相关（比值比[OR]0.23，95%置信区间[CI]0.08 - 0.65）。出现感觉异常或感觉减退的患者在症状出现超过6个月后接受手术时，预后有更差的趋势（OR 0.37，95% CI 0.13 - 1.06）。即使经过荟萃分析，预后也不会因高龄（OR 0.70，95% CI 0.24 - 1.98）或患者性别（OR 1.13，95% CI 0.42 - 3.06）而有所不同。
作者将其机构的数据与已发表的关于腓总神经减压术后结果的数据相结合。预后通常良好，一般不受术前症状类型的影响，特别是如果患者无糖尿病且术前症状持续时间少于12个月。出现感觉异常的患者可能在症状出现后6个月内从手术中获益。吸烟可能对手术结果产生不利影响。最后，高龄不会对预后产生不利影响，老年患者应考虑接受手术。
