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Dynamic factors involved in common peroneal nerve entrapment neuropathy

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Abstract

Background

Common peroneal nerve (CPN) entrapment neuropathy (CPNEN) is the most common peripheral neuropathy of the lower extremities. The pathological mechanisms underlying CPNEN remain unclear. We sought to identify dynamic factors involved in CPNEN by directly measuring the CPN pressure during stepwise CPNEN surgery.

Methods

We enrolled seven patients whose CPNEN improved significantly after CPN neurolysis. All suffered intermittent claudication, and the repetitive plantar flexion test, used as a CPNEN provocation test, was positive. During decompression surgery we directly measured the CPN pressure during several decompression steps.

Results

Before CPN decompression, plantar flexion elicited a statistically significant increase in the CPN pressure (from 1.8 to 37.3, p < 0.05), as did plantar extension (from 1.8 to 23.1, p < 0.05). The CPN pressure gradually decreased during step-by-step surgery; it was lowest after resection of the peroneus longus muscle (PLM) fascia.

Conclusions

Dynamic factors affect idiopathic CPNEN. The CPN pressure decreased at each surgical decompression step, and removal of the PLM fascia resulted in adequate decompression of the CPN. Our findings shed light on the etiology of idiopathic CPNEN and recommend adequate CPNEN decompression procedures.

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Authors and Affiliations

  1. Department of Neurosurgery, Nippon Medical School, Tokyo, 113-8603, Japan

    Takao Kitamura, Daijiro Morimoto & Akio Morita

  2. Department of Neurosurgery, Chiba Hokuso Hospital, Nippon Medical School, 1715, Kamagari, Inzai-city, Chiba, 270-1694, Japan

    Kyongsong Kim & Rinko Kokubo

  3. Department of Neurosurgery, Teikyo University Hospital, Tokyo, 173-8606, Japan

    Naotaka Iwamoto

  4. Department of Neurosurgery, Kushiro Rosai Hospital, Hokkaido, 085-8533, Japan

    Toyohiko Isu

Authors
  1. Takao Kitamura
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  2. Kyongsong Kim
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  3. Daijiro Morimoto
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  4. Rinko Kokubo
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  5. Naotaka Iwamoto
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  6. Toyohiko Isu
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  7. Akio Morita
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Corresponding author

Correspondence to Kyongsong Kim.

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Conflict of interest

None.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Funding

No funding was received for this research.

Informed consent

Informed consent was obtained from all individual participants included in the study.

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Comments

A well designed and executed study that supports its hypothesis that the common peroneal nerve in the lower leg is subject to dynamic compression exacerbated by certain foot postures and that surgical decompression relieves the increased pressure

Michel Kliot

California, USA

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Kitamura, T., Kim, K., Morimoto, D. et al. Dynamic factors involved in common peroneal nerve entrapment neuropathy. Acta Neurochir 159, 1777–1781 (2017). https://doi.org/10.1007/s00701-017-3265-2

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  • DOI: https://doi.org/10.1007/s00701-017-3265-2

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