Dynamic factors involved in common peroneal nerve entrapment neuropathy

One-stage Neurorrhaphy and Posterior Transposition with Gastrocnemius Fascial Flap for Common Peroneal Nerve Injury: Preliminary Results

OBJECTIVE

Common peroneal nerve (CPN) injury is a frequently encountered lower extremity injury. Furthermore, several previous studies have demonstrated that patients who underwent direct suturing of the CPN following rupture experienced unfavorable postoperative prognoses. Therefore, we aimed to present a novel modified surgical approach for CPN rupture and assess the effectiveness of this technique in restoring lower limb functionality.

METHODS

In this retrospective observational study, we included patients with CPN rupture who underwent one-stage neurorrhaphy and posterior transposition combined with nerve wrapping using a gastrocnemius fascial flap for CPN rupture between January 2016 and December 2020. Lower limb function was evaluated using the lower extremity functional scale (LEFS) and British Medical Research Council (BMRC) grading system. We also assessed the influence of age, sex, duration of symptoms, mechanism of injury, and surgical modality on the postoperative recovery of lower extremity function using subgroup and regression analyses.

RESULTS

Thirty-seven patients (mean age = 35.76 ± 13.01 years) with at least 2 years of follow-up were included in the final analysis. The LEFS scores significantly improved after surgery at the last follow-up (p < 0.01). Moreover, 67.57% of the patients achieved good or excellent postoperative outcomes (BMRC: M3 or above). Results of the subgroup analysis and regression models suggested that patients who underwent direct suturing showed better recovery of lower extremity function than those who underwent nerve grafting.

CONCLUSION

One-stage neurorrhaphy and posterior transposition combined with nerve wrapping using a gastrocnemius fascial flap exhibited encouraging outcomes in restoring lower-limb function among patients with CPN rupture. This novel surgical technique is expected to be an effective method for treating CPN ruptures in the future.

Surgical Outcomes of Common Peroneal Nerve Entrapment Neuropathy Associated with L5 Radiculopathy

Impingement of the common peroneal nerve, a branch of the L5 nerve root, causes common peroneal nerve entrapment neuropathy (CPNE). Although there are cases of CPNE associated with L5 radiculopathy, surgical intervention's effectiveness remains to be elucidated. This retrospective case-control study aimed to evaluate the efficacy of surgery in patients with CPNE associated with L5 radiculopathy. Twenty-two patients (25 limbs) with surgically treated CPNE between 2015 and 2022 were retrospectively reviewed. The limbs were classified into two groups: group R (limbs of CPNE associated with L5 radiculopathy) and group O (limbs of CPNE without L5 radiculopathy). The durations from onset to surgery, the nerve conduction studies (NCSs), and postoperative improvement rates for motor weakness, pain, and dysesthesia were compared between the groups. Group R included 15 limbs (13 patients), and group O included 10 limbs (9 patients). There were no significant differences in the duration from onset to surgery or abnormal findings of NCS between the two groups. The postoperative improvement rates were 88% and 100% (p = 0.62) for muscle weakness, 87% and 80% (p = 0.53) for pain, and 71% and 56% (p = 0.37) for dysesthesia in group R and group O, respectively, without significant differences between groups. CPNE associated with L5 radiculopathy is common, and the results of the present study showed that the surgical outcomes in such cases were satisfactory and comparable to those in CPNE without L5 radiculopathy.

Biological Approach in the Treatment of External Popliteal Sciatic Nerve (Epsn) Neurological Injury: Review

The external popliteal sciatic nerve (EPSN) is the nerve of the lower extremity most frequently affected by compressive etiology. Its superficial and sinuous anatomical course is closely related to other rigid anatomical structures and has an important dynamic neural component. Therefore, this circumstance means that this nerve is exposed to multiple causes of compressive etiology. Despite this fact, there are few publications with extensive case studies dealing with treatment. In this review, we propose to carry out a narrative review of the neuropathy of the EPSN, including an anatomical reminder, its clinical presentation and diagnosis, as well as its surgical and biological approach. The most novel aspect we propose is the review of the possible role of biological factors in the reversal of this situation.

Double Crush Syndrome of the Lower Limb in L5 Radiculopathy and Peroneal Neuropathy: A Case Report

Double crush syndrome (DCS) is a clinical condition involving impingement of the spinal and peripheral nerves. DCS of the lower limbs has been recognized; however, no detailed reports have been published. Herein, we report a rare case of the coexistence of L5 radiculopathy and peroneal nerve entrapment neuropathy. The patient suffered from pain in the left lower leg and left foot combined with muscle weakness in the left leg without a Tinel-like sign in the peroneal tunnel area. MRI showed a deficit in the left L5 nerve root sleeve, and X-ray imaging revealed L5 spondylolysis. Lumbar fusion surgery was performed at L5-S1. Subsequently, the patient’s symptoms were partially improved, but the pain and toe and ankle motor weakness persisted. In addition, a Tinel-like sign appeared at the entrapment point of the peroneal nerve. The entrapped peroneal nerve was decompressed, and the patient’s symptoms improved. The patient had L5 radiculopathy owing to the improvement in his symptoms in the upper leg before and after lumbar surgery. It is unclear why no Tinel-like sign was detected before the first surgery, but we hypothesized that L5 nerve disorder may mask the symptoms triggered by compression of the peroneal nerve due to the complex pathology of DCS and dynamic factors. Distinguishing between radiculopathy and relative peripheral neuropathy should always be a consideration. DCS may mask characteristic symptoms, and it is important to carefully follow up the patient to detect changes in his or her condition.

Thread common peroneal nerve release-a cadaveric validation study

OBJECTIVE

To determine if the thread release technique can be applied to common peroneal nerve entrapment at the fibular neck.

METHODS

The thread common peroneal nerve release was performed on 15 fresh frozen cadaveric lower extremity specimens. All procedures were performed under ultrasound guidance and immediately underwent post-procedural gross anatomic inspection for completeness of decompression and presence or absence of iatrogenic neurovascular injury.

RESULTS

All 15 specimens demonstrated complete transection of the deep fascia of the peroneus longus overlying the common peroneal nerve. The transections extended to the bifurcation of the superficial peroneal and deep peroneal nerves. There was no evidence of any iatrogenic damage to the neurovascular bundle or adjacent tendons. The average operating time was less than 30 min.

CONCLUSION

This cadaveric validation study demonstrates the accuracy of the thread common peroneal nerve release. Future pilot studies are warranted to ensure the safety of this procedure in the clinical setting.