Decompressive surgery for treating nerve damage in leprosy

Decompression surgery as add-on treatment to oral prednisolone might possibly not be beneficial in the treatment of nerve damage in leprosy, but the evidence is insufficient.

A Cochrane review included 2 studies with a total of 88 subjects. Both tested decompression surgery plus oral corticosteroids versus oral corticosteroids alone. The interventions and outcomes were too heterogeneous to be combined in a meta-analysis. After two 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 decompressive surgery were not adequately described.

Comment: The quality of evidence is downgraded by imprecise results (few patients and wide confidence intervals), by inconsistency (heterogeneity in interventions and outcomes), and by study quality (more than 20% loss to follow up).

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1. Van Veen NH, Schreuders TA, Theuvenet WJ, Agrawal A, Richardus JH. Decompressive surgery for treating nerve damage in leprosy. Cochrane Database Syst Rev 2009 Jan 21;(1):CD006983 [Review content assessed as up-to-date: 3 August 2010].
2. Van Veen NH, Schreuders TA, Theuvenet WJ et al. Decompressive surgery for treating nerve damage in leprosy. Cochrane Database Syst Rev 2012;12():CD006983. .