Introduction: Common Peroneal Nerve (CPN) neuropathy is the most common entrapment neuropathy of the lower extremities. Patients present with sensory loss along the anterolateral leg and dorsum of the foot, or weakness of the foot dorsiflexors and evertors.
Methods: This is an IRB-approved retrospective review of a prospectively maintained database of patients who underwent decompressive surgery for CPN neuropathy with a minimum of 3 months follow up at Loyola University Medical Center. Motor scores were totaled using the Oxford Scale, with an improvement defined as resolution of pain or sensory loss or improvement in motor score by at least a 1-grade.
Results: 30 patients were analyzed. Of the 26 patients who presented with abnormal lower extremity motor scores, 24 had at least 1 grade improvement in motor scores, and 2 experienced no change. 26 patients presented with lower extremity decreased sensation, and 12 of these patients reported improved sensation, while 14 patients reported no change. Patients with an increased time to surgery (>67 weeks) had a non-significant trend towards worse outcomes (p=.06). Patients who presented with weakness had a significant trend towards improvement (p=.0006) compared to patients presenting with pain and sensory deficits.
Conclusions: Surgical decompression of the CPN at the lateral fibular neck is an effective and safe procedure. Patients presenting with pain or sensory loss did not show a significant trend towards improvement with surgery, while patients presenting with motor deficits had a significant improvement with surgery. There was a trend of worse outcomes with a symptoms-to-surgery time greater than 67 weeks.
Patient Care: By understanding which particular symptoms of CPN injury are indicative of post-operative improvement, neurosurgeons will be able to directly improve the quality of life of their patients. This study displays the post-operative motor function improvement of patients presenting with weakness and the lack of improvement of patients presenting with sensory deficits. This evidence will allow neurosurgeons to more accurately advise patients on whether or not they are good candidates for CPN neuroplasty.
Learning Objectives: By the conclusion of this session, participants should be able to:
1) Describe the importance of presentation of CPN injury (weakness, sensory deficit, pain etc.) and time from symptoms to surgery on post-operative motor and sensory improvement.
2) Discuss in small groups the difference in post-operative motor function improvement between patients presenting with weakness and patients presenting with sensory deficits.
3) Identify an effective treatment for patients presenting with weakness in foot dorsiflexion or eversion.