Decompressive surgery for treating nerve damage in leprosy
Abstract
Background
Leprosy causes nerve damage which may result in nerve function impairment and disability. Decompressive surgery is used for treating nerve damage, although the effect is uncertain.
Objectives
To assess the effects of decompressive surgery on nerve damage in leprosy.
Search methods
We searched the Cochrane Neuromuscular Disease Group Specialized Register (4 August 2010), the Cochrane Central Register of Controlled Trials (Issue 3, 2010 in The Cochrane Library), MEDLINE (January 1966 to July 2010), EMBASE (January 1980 to July 2010), AMED (January 1985 to July 2010), CINAHL Plus (January 1937 to July 2010) and LILACS (from January 1982 to July 2010). We checked reference lists of the studies identified, the Current Controlled Trials Register (www.controlled‐trials.com) (February 2010), conference proceedings and contacted trial authors.
Selection criteria
Randomised and quasi‐randomised controlled trials of decompressive surgery for nerve damage in leprosy.
Data collection and analysis
The primary outcome was improvement in sensory and motor nerve function after one year. Secondary outcomes were improvement in nerve function after two years, change in nerve pain and tenderness, and adverse events. Two authors independently extracted data and assessed trial quality. We contacted trial authors for additional information. We collected adverse effects information from the trials and non‐randomised studies.
Main results
We included two randomised controlled trials involving 88 participants. The trials examined the added benefit of surgery over prednisolone for treatment of nerve damage of less than six months duration. After two years follow‐up there was no significant difference in nerve function improvement between participants treated with surgery plus prednisolone or with prednisolone alone. Adverse effects of decompressive surgery were not adequately described.
Authors' conclusions
Decompressive surgery is used for treating nerve damage in leprosy but the available evidence from randomised controlled trials was of very low quality and does not show a significant added benefit of surgery over steroid treatment alone. Well‐designed randomised controlled trials are needed to establish the effectiveness of the combination of surgery and medical treatment compared to medical treatment alone.
Plain language summary
Decompressive surgery for treating nerve damage in leprosy
Leprosy is a chronic infectious disease. Leprosy bacteria cause damage to skin and peripheral nerves which may result in nerve function impairment and disability. Decompressive surgery is used for treating nerve damage although its effect is uncertain. Two randomised controlled trials were included in the review and examined the added benefit of surgery over prednisolone for treatment of nerve damage of less than six months duration. Two years from the start there was no significant difference in nerve function improvement between people treated with surgery plus prednisolone or with prednisolone alone. Adverse effects of decompressive surgery were not adequately described.
