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  • Surgical Results of Common Peroneal Nerve Neuroplasty at Lateral Fibular Neck

    Final Number:
    1249

    Authors:
    Kevin Swong MD; Vikram C. Prabhu MD, MS; David Freeman MD, PhD, MS

    Study Design:
    Other

    Subject Category:

    Meeting: Congress of Neurological Surgeons 2016 Annual Meeting

    Introduction: Common peroneal nerve (CPN) compressive neuropathy is the most common lower extremity entrapment neuropathy.

    Methods: A retrospective review of a prospectively maintained single-institution database of all cases of CPN palsy that underwent decompression and neuroplasty over a five- year period was performed.

    Results: Sixteen patients underwent neuroplasty of the CPN over the five years at our institution. The average age was 44 years with a male preponderance (56%). A neuropraxic injury following a prior unrelated surgical procedure was noted in 7 patients. In 8 patients, an injury to the ipsilateral extremity preceded the onset of CPN palsy. The most common presentation was weakness of CPN supplied muscles and loss of sensation in the distribution of the CPN. Pain was a presenting symptom in 9 patients. The most common muscles with diminished strength were the tibialis anterior and extensor halluces longus. Only five patients had a positive Tinel’s sign at the site of compression. Mean follow up was 28 months. Prone positioning provided excellent surgical exposure of the CPN from the distal thigh to the peroneal tunnel. Clinical improvement following surgery was noted in 14 of the 16 patients; two patients had no change in their exam. The most consistent improvement was noted in the TA (p=0.02) and EHL (p=0.03); a trend towards greater improvement with shorter time to surgery was noted. No complications related to the surgical site or CPN were encountered and no patient had a decline in neurological exam as a consequence of the surgery. One patient developed a positioning related right upper extremity brachial plexus neuropraxic injury following surgery that recovered completely.

    Conclusions: Common peroneal neuropathy usually presents with a foot drop and decreased sensation or pain in the distribution of the CPN. Surgical neuroplasty of the CPN at the lateral fibular neck in a prone position allows decompression of the nerve from the distal thigh to the peroneal tunnel in the proximal leg. Significant improvement in motor strength following surgery, particularly of the TA and EHL may be noted. A trend towards greater recovery with decreased time to surgery is also noted.

    Patient Care: It will allow clinicians to incorporate an easy and effective procedure into their practice

    Learning Objectives: To help clinicians recognize the signs of common peroneal neuropathy and initial workup and management strategies including our technique for common peroneal neuroplasty

    References: 1. Robinson, L.R., Traumatic injury to peripheral nerves. Muscle Nerve, 2000. 23(6): p. 863-73. 2. Maalla, R., et al., Peroneal nerve entrapment at the fibular head: outcomes of neurolysis. Orthop Traumatol Surg Res, 2013. 99(6): p. 719-22. 3. Marciniak, C., Fibular (peroneal) neuropathy: electrodiagnostic features and clinical correlates. Phys Med Rehabil Clin N Am, 2013. 24(1): p. 121-37. 4. Mahan, M., Neurosurgery Knowledge Update. 115 Common Peroneal Entrapment across the Fibular Head, ed. R.E. Harbaugh. Vol. 1. 2015, Verlagsgruppe, Stuttgart, New York, Delhi, Rio: Thieme. 5. Calhoun, J. http://emedicine.medscape.com/article/1234607-treatment. 2015 [cited 2015 August 27]. 6. Boyd, K.U.B., Justin M, Injury and Compressive Neuropathy in the Lower Extremity, in Nerve Surgery, S.E.Y. Mackinnon, Andrew, Editor. 2015, Thieme: Verlagsgruppe, Stuttgart, New York, Delhi, Rio. 7. Spinner, R.J., J.L. Atkinson, and R.L. Tiel, Peroneal intraneural ganglia: the importance of the articular branch. A unifying theory. J Neurosurg, 2003. 99(2): p. 330-43. 8. Marciniak, C., et al., Practice parameter: utility of electrodiagnostic techniques in evaluating patients with suspected peroneal neuropathy: an evidence-based review. Muscle Nerve, 2005. 31(4): p. 520-7. 9. Dellon, A.L., J. Ebmer, and P. Swier, Anatomic variations related to decompression of the common peroneal nerve at the fibular head. Ann Plast Surg, 2002. 48(1): p. 30-4. 10. Derr, J.J., P.J. Micklesen, and L.R. Robinson, Predicting recovery after fibular nerve injury: which electrodiagnostic features are most useful? Am J Phys Med Rehabil, 2009. 88(7): p. 547-53. 11. Katirji, B., Electromyography in Clinical Practice. 2007, Philadelphia, PA: Elsevier. 12. Thoma, A., et al., Decompression of the common peroneal nerve: experience with 20 consecutive cases. Plast Reconstr Surg, 2001. 107(5): p. 1183-9. 13. Ryan, W., et al., Relationship of the common peroneal nerve and its branches to the head and neck of the fibula. Clin Anat, 2003. 16(6): p. 501-5. 14. Ducic, I. and J.M. Felder, Minimally invasive peripheral nerve surgery: peroneal nerve neurolysis. Microsurgery, 2012. 32(1): p. 26-30. 15. Moore KL, A.A., Dalley, AF, Clinically Oriented Anatomy, ed. A.A. Moore KL, Dalley AF. Vol. 6. 2010, Baltimore: Lippincott Willaims & Wilkins. 16. Meyer, T.N., et al., Decompression of the common peroneal nerve: experience with 20 consecutive cases. Plast Reconstr Surg, 2002. 109(5): p. 1755-6; author reply 1756. 17. Cruz-Martinez, A., J. Arpa, and F. Palau, Peroneal neuropathy after weight loss. J Peripher Nerv Syst, 2000. 5(2): p. 101-5. 18. Van Langenhove, M., A. Pollefliet, and G. Vanderstraeten, A retrospective electrodiagnostic evaluation of footdrop in 303 patients. Electromyogr Clin Neurophysiol, 1989. 29(3): p. 145-52. 19. NIH. Charcot-Marie-Tooth Disease Fact Sheet. 2015 [cited 2015 August 27]. 20. Fabre, T., et al., Peroneal nerve entrapment. J Bone Joint Surg Am, 1998. 80(1): p. 47-53.

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