2021 Volume 30 Issue 8 Pages 562-569
Peripheral nerve neuropathy due to nerve entrapment is not uncommon. Peripheral nerve entrapment (PN-EN) must be differentiated from brain and spinal cord diseases ; its treatment requires less invasive microsurgery. As many patients with numbness or paralysis of the extremities are seen in the neurosurgery outpatient clinic, we recommend that neurosurgeons incorporate the treatment of PN-EN into their daily practice and provide some suggestions.
The diagnosis of PN-EN is performed in 5 steps. (1) Does the patient present with a single neuropathy. (2) Is the symptom exacerbated when a load is applied (the provocation test may be useful). (3) Is there a Tinel-like sign at the suspected entrapment site. (4) Nerve blocks may be diagnostic. (5) Electrophysiological and magnetic resonance studies may be useful.
When patients report to the outpatient clinic complaining of hand numbness, carpal tunnel syndrome must first be ruled out. When they present with numbness of the lower limbs, 3 areas must be checked. (1) The anterior lateral thigh (lateral femoral cutaneous neuropathy), (2) the instep from the outside of the lower leg (common peroneal neuropathy), and (3) the sole of the foot (tarsal tunnel syndrome).
Para-lumbar spine diseases are also often encountered in patients seen on an outpatient basis. We recommend that the neurosurgeon divide the pain area into 3 areas, (1) around the iliac crest (superior cluneal neuropathy), (2) the medial buttock (middle cluneal neuropathy), and (3) the lateral buttock (gluteus medius muscle pain and piriformis syndrome).
The diagnosis and treatment of these diseases require the elucidation of the pathological background and the development of diagnostic tools. We encourage Japanese neurosurgeons to incorporate the diagnosis and treatment of PN-EN into their daily practice and suggest that PN-EN treatment be recognized as an area of Japanese neurosurgery.
