Surgical Nerve Decompression at Lower Extremity for Diabetic Neuropathy: A Systematic Review and Meta-Analysis of Time-Dependent Pain, Sensory Recovery, Amputation, Ulcer Recurrence, and Balance.

OBJECTIVE

This systematic review and meta-analysis evaluated the efficacy of surgical nerve decompression in patients with diabetic peripheral neuropathy, focusing on pain relief over time, comprehensive sensory function, reduction in ulcer recurrence, amputation prevention, and balance improvement.

METHODS

Databases including PubMed, Scopus, and Web of Science were systematically searched up to January 8, 2025. Eighteen studies (4 randomized controlled trials and 14 observational studies; total n = 837) met inclusion criteria. Primary outcomes were pain relief and sensory recovery; secondary outcomes were ulcer recurrence, amputation rates, and balance. Data synthesis employed random-effects or fixed-effects models with heterogeneity and publication bias assessments.

RESULTS

Surgical decompression significantly reduced pain at short-term (6 months: standardized mean difference [SMD]: 2.40, P < 0.001), medium-term (12 months: SMD: 2.02, P = 0.014), and long-term (> 12 months: SMD: 3.24, P = 0.009) follow-ups. Meta-regression revealed modest attenuation of pain relief over time (R2 = 33.1%). Continuous measures indicated significant sensory improvements (SMD: 2.19, P = 0.012), although categorical controlled comparisons were inconclusive. Surgical intervention significantly reduced ulcer recurrence (log odds ratio: 1.03, P < 0.001) and amputation rates (log odds ratio: 2.06, P = 0.018), while improvements in balance showed a positive, yet nonsignificant, trend.

CONCLUSIONS

Surgical nerve decompression demonstrates sustained efficacy in pain management and substantially reduces severe diabetic neuropathy complications. Future high-quality randomized controlled trials are necessary to standardize outcomes and confirm long-term benefits.