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Decompressive surgery for treating nerve damage in leprosy. A Cochrane review
Natasja H.J. Van Veen
  Natasja H.J. Van Veen
Affiliation
Department of Public Health, Erasmus MC, University Medical Center Rotterdam, The Netherlands
Correspondence to: Natasja H. J. van Veen, Department of Public Health, Erasmus MC, University Medical Center Rotterdam, PO Box 2040, 3000 CA, The Netherlands (e-mail: n.vanveen@erasmusmc.nl)
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a,*
Ton A.R. Schreuders
  Ton A.R. Schreuders
Affiliation
Rehabilitation Medicine, Erasmus MC, University Medical Center Rotterdam, The Netherlands
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b
Willem J. Theuvenet
  Willem J. Theuvenet
Affiliation
Plastic Surgery, Regional Hospitals of Apeldoorn, Deventer and Zutphen, Apeldoorn, The Netherlands
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c
Amit Agrawal
  Amit Agrawal
Affiliation
Division of Neurosurgery, Datta Meghe Institute of Medical Sciences, Wardha, India
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d
Jan Hendrik Richardus
  Jan Hendrik Richardus
Affiliation
Department of Public Health, Erasmus MC, University Medical Center Rotterdam, The Netherlands
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a
Objective

Decompressive surgery is used for treating nerve damage in leprosy. We assessed the effectiveness of decompressive surgery for patients with nerve damage due to leprosy.

 Methods

A broad search strategy was performed to find eligible studies, selecting randomised controlled trials (RCTs) comparing decompressive surgery alone or plus corticosteroids with corticosteroids alone, placebo or no treatment. Two authors independently assessed quality and extracted data. Where it was not possible to perform a meta-analysis, the data for each trial was summarised.

 Results

We included two randomised controlled trials involving 88 people. The trials examined the added benefit of surgery over prednisolone for treatment of nerve damage of less than 6 months duration. After 2 years follow-up there was no significant difference in nerve function improvement between people treated with surgery plus prednisolone or with prednisolone alone. Adverse effects of decompression surgery were not adequately described.

 Conclusions

Evidence from randomised controlled trials 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.
Cite this article
Natasja H.J. Van Veen, Ton A.R. Schreuders, Willem J. Theuvenet, Amit Agrawal, Jan Hendrik Richardus;
Decompressive surgery for treating nerve damage in leprosy. A Cochrane review; Leprosy Review; 2009; 80; 1; 3-12; DOI: 10.47276/lr.80.1.3
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DOI: 10.47276/lr.80.1.3

articleview.journal_title: Leprosy Review
articleview.publisher: British Leprosy Relief Association
articleview.publisher_location: Colchester, UK
articleview.article_date_pre accepted on 02 January 2009 and articleview.pub_on 01 March 2009
© Lepra 2009
LEPROSY
Leprosy Review
0305-7518
British Leprosy Relief Association
Colchester, UK
00-0312
0305-7518/09/064053+10
10.47276/lr.80.1.3
Original Papers
Decompressive surgery for treating nerve damage in leprosy. A Cochrane review
N. H. J. van Veen et al.
Review of surgery for nerve damage
Van VeenNatasja H.J.
a
SchreudersTon A.R.
b
TheuvenetWillem J.
c
AgrawalAmit
d
RichardusJan Hendrik
a
a
Department of Public Health, Erasmus MC, University Medical Center Rotterdam, The Netherlands
b
Rehabilitation Medicine, Erasmus MC, University Medical Center Rotterdam, The Netherlands
c
Plastic Surgery, Regional Hospitals of Apeldoorn, Deventer and Zutphen, Apeldoorn, The Netherlands
d
Division of Neurosurgery, Datta Meghe Institute of Medical Sciences, Wardha, India
Correspondence to: Natasja H. J. van Veen, Department of Public Health, Erasmus MC, University Medical Center Rotterdam, PO Box 2040, 3000 CA, The Netherlands (e-mail: )
01032009
80
1
3
12
02012009
© Lepra
2009
Objective
Decompressive surgery is used for treating nerve damage in leprosy. We assessed the effectiveness of decompressive surgery for patients with nerve damage due to leprosy.
Methods
A broad search strategy was performed to find eligible studies, selecting randomised controlled trials (RCTs) comparing decompressive surgery alone or plus corticosteroids with corticosteroids alone, placebo or no treatment. Two authors independently assessed quality and extracted data. Where it was not possible to perform a meta-analysis, the data for each trial was summarised.
Results
We included two randomised controlled trials involving 88 people. The trials examined the added benefit of surgery over prednisolone for treatment of nerve damage of less than 6 months duration. After 2 years follow-up there was no significant difference in nerve function improvement between people treated with surgery plus prednisolone or with prednisolone alone. Adverse effects of decompression surgery were not adequately described.
Conclusions
Evidence from randomised controlled trials 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.