Triple nerve decompression surgery
 

Hi All!!

Obviously, Alan is still on a quest to find some relief for his neuropathy.

He found a website that discussed Triple Nerve Decompression Surgery for people with Neuropathy. I called them up and there is success in doing this but the place is in New Jersey.

Since Alan has already been operated on by his own orthopedic surgeon (it wasn't a nerve decompression surgery), but it was some kind of surgery on his calf to ease the pressure in his foot so the foot ulcer would not re-occur.

This was not successful.

Here is the information on Decompression Surgery that I just got off of the internet. Please let me know if any of you have heard of this and what you think.

Alan has the neuropathy between the pinky toe to the middle toe on the right foot, and on the left foot, the big toe to the next toe.

These are the only toes that have the BAD TINGLING BETWEEN THEM.

Here's the info:

The triple-nerve decompression procedure-in which ligament release relieves pressure on the tibial, deep peroneal, and common peroneal nerves-was first described by Dellon in Plastic Reconstructive Surgery in April 1992 (Dellon AL. Plast Reconstr Surg. 1992;89:689-697). In that study and 6 others published by Dellon and his trainees since then, the procedure has been associated with pain relief in 85% to 92% of patients and improved sensation in 50% to 72%. In those study populations combined, no ulcers developed in any of the patients who did not have a previous history of ulceration, and only 1 ulcer developed in the 29 patients who had a history of ulceration


Any comments are welcome. He's tried ALL THE MEDS. Nothing gives relief. He does do the bio-freeze at night, but honestly, if this decompression thing works on the nerves in the feet to release them, well, he'll give it a try.
Thanks much

Melody

Hi Melody,

I haven't heard of this, and have absolutely no qualifications for judging this based on the data. But the success rate sure does look good! I would certainly see if I could find any more info first, but if I could only base it on what you told us, and could safely assume that it's true, I would do it in a heartbeat. That's all I can tell you--what I would do.

Good luck with this. I really, really hope that it's the answer and that it can help Alan!

Hi Melody,

John and I met a doc who does this procedure. He's does plastic surgery and wound stuff in addition to the micro-surgery he does. His link is posted below in case you want to read more about it/him.

John went to him in 2003 for a wound he had from the hickman central line in his chest that got infected. He did speak to us about the surgery for the PN but John was in no shape to undergo more treatment at the time. Luckily, John's PN has improved quite a bit since then and I don't think he would risk surgery at this point. For us, there's always a fear that it will be worse after the surgery and he been through enough in the past 7 years. I don't remember the success rate with this procedure but you need to ask them to break down what their statistics mean. How do they define success?

How many have 100% relief and for how long?
How many have had noticeable improvement?
How many have had no improvement?
How many had more pain/symptoms after the surgery?
What are the potential side effects/complications?


http://www.georgetownuniversityhospi...dy.cfm?id=1656

There's always a risk that comes with surgery so make sure you get the best doc who has done lots of these procedures successfully. It sounds like they can tell upfront fairly easily if Alan is a good candidate for this procedure. You can always go for a consult...there's no harm in checking (except for the $$$ you'll spend).

if you do a search on Dellon here and at other peripheral neuropathy boards there have been a lot of posts about this in the past. The record for this is very mixed at best.

thanks to you and all who replied.

I'll do a search on Dellon as you suggested.

I also called up the Neuropathy Center at Cornell. I told them all about Alan and told them what tests he has had done. I then asked her if they do anything different. She was very honest, she said "no, it seems like he's had all the necessary tests"

So then I called up Alan's ortho guy who did the other surgery. I spoke to his assistant and asked her if the ortho did that particular procedure.

She got back to me and said "The doctor says it all depends on how his last emg turned out." Since I have all of Alan's records, this was a simple task.

I couldn't fax them to her because all the pages came out black at her end.

so I made copies, went to the post office and mailed them to her.

His ortho will look at Alan's emg and make his determination.

Hey, it's a start.

And thanks for the information.

Melody

It would seem to me that the main question--
 

--in determining whether this surgery would have a chance at helping is just where the neuropathy stems from.

Symptoms in the toes can be caused right there, in the foot, the calf, at the knee (the peroneal nerve is particularly prone to compression there), the thigh, the pelvis, the lumbosacral spine, or even higher. A well-done EMG/NCV might be able to pinpoint just where the signal disruption originates from, maybe (if it's big enough to be seen in the larger nerves and is not small-fiber caused).

In fact, take a look at:

http://emedicine.medscape.com/article/1141734-overview

http://www.utmem.edu/gim/smalltalks/le-neuropathy.pdf

http://emedicine.medscape.com/article/1234809-overview


It would seem to me that such a "triple" release would involve cutting high up on the thigh or near the hip to get at all the origins of the nerve branches there; is that where the surgery is done, or are there several seperate incisions involved?

Here is an article on the subject:
http://www.podiatrytoday.com/article/7064

This surgery I believe is only done on the foot.

This article explains how nerves can swell up (sorbitol builds up in them from faulty glucose metabolism--- I'd avoid sorbitol in all foods too)

I know one test for nerve compression is to tap briskly the top of the foot and see it you get a zing to the toes. (I have a positive sign for this).

I think tying shoes too tightly also contributes to this. I put up a link recently showing alternate ways to tie shoes, and started doing that myself. I have had great success with foot comfort since doing so. Tying shoes over those nerves, in effect may compress them more if compressive issues are already present.

Hypothyroidism also leads to compressive issues. Low thyroid deposits a kind of tissue that swells the ligaments and therefore squeezes the tiny tunnel the nerves go thru. Fluid retention, like from Neurontin/Lyrica or other drugs may do this too.

At one time, the Dellon pre-requisites for consideration and testing to see if one qualifies for the 'Dellon Procedure'..... were in question.
He took no insurance and it seems that just about everyone qualified for his testing procedur, that was costly.
His success rates were for decompression type surgeries only.
Diabetics were the majority of his patients.
He has taken his procedure, taught it, and licensed or franchised it- to surgeons all over the country and has a financial stake in many, if not all of them.
He originated it in Baltimore at Johns Hopkins and had (may still be) an independent and separate office for this. I know that at one time he was no longer affiliated with JHH, but that may have changed recently.
Posts about successes, on this and other BB's seem to be mixed.

Knees and ankles....
 

were the places where John would have had the incisions...so it would be multiple incisions. He said he would go in and "clean" out the debris that has accumulated in the areas.

And from what I understand....post-op is pretty critical to the outcome of the surgery also. Those who ignore post-op procedure don't do as well.

Mrs. D.

I just did the briskly tapping over Alan's right foot (where the pinky toe is).

he said it ZINGED.

Onward and upward!!!

lol

Melody
P.S. Thanks to ALL of you for the good info. I'm going to read ALL of it.

Oh, one more important thing I forgot to mention.

When I called the place in New Jersey (that does this triple nerve thing, I asked the nursing assistant.

What happens in the foot to cause neuropathy? and she said

"Well, the nerves are being strangled"

I have no clue if she's right or wrong.