Liste-23

SURGICAL MANAGEMENT OF CHRONIC LOWER EXTREMITY NEUROPATHIC PAIN

Schon LC, Easley ME, Lam PW-C, Anderson CD, Trnka H-J, Lumsden DB, Levin G, and Shanker J

Purpose: To review the results of a surgical algorithm for managing intractable foot and ankle pain.

Methods: We reviewed 145 lower extremity peripheral nerve procedures in 112 patients to develop a surgical algorithm and determine its efficacy. Duration of symptoms averaged 37 months (range, 6 to 120 months). Mechanisms of nerve injury included chronic transection (37 cases), crush (35), adhesive neuralgia (25), stretch (20), repetitive trauma (12), and idiopathic (13). The treatment algorithm included: transection/containment (61), with (25) or without peripheral nerve stimulation for crush, stretch, and chronic transection injuries; revision neurolysis with vein wrapping (37) for adhesive neuralgia; and primary (12) or revision neurolysis (12) for repetitive trauma. Patients were evaluated subjectively (questionnaire) and clinically. Pain and dysfunction were ranked from 0 (no pain/dysfunction) to 10 (pain prompting request for amputation/wheelchair use); preoperative and follow-up work status were documented.

Result: Follow-up averaged 38 months (range, 24 to 96 months). Average pain scores improved from 8.8 points (range, 5 to 10 points) to 5.6 points (range, 0 to 10 points); average dysfunction improved from 7.6 points (range, 2 to 10 points) to 5.0 points (range, 0 to 10 points). Of the 112 patients, 52 (46%) improved their work status, including 33/85 (40%) involved in workman's compensation. One-way ANOVAs (comparing outcome based on mechanism of nerve injury or type of procedure) revealed no statistically significant differences (p > 0.05).

Conclusion: Intractable foot and ankle pain can be improved with treatment via a surgical algorithm.