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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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.
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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