Open in situ decompression best for cubital tunnel decompression: JAMA
Cure rate for patients with cubital tunnel syndrome who receive surgery is high and complications are uncommon.
UK: Open in situ decompression is the most beneficial operation for adults with primary cubital tunnel syndrome, suggests a recent study in the journal JAMA Network Open. According to the study, the procedure was safest and was associated with best outcomes.
Cubital tunnel syndrome is the second most common compressive neuropathy and affects 6% of the population. For its treatment, numerous operation are performed globally however the studies have not been able to determine the procedure associated with fewest complications and best outcomes.
Ryckie G. Wade, Leeds Teaching Hospitals Trust, Leeds, United Kingdom, and colleagues evaluated which operation for cubital tunnel syndrome is associated with the greatest likelihood of symptomatic cure.
The researchers searched the online databases from inception to March 2, 2019. They included studies that compared the outcomes of at least 2 surgical treatments for adults with primary cubital tunnel syndrome. Case reports were excluded, and when comparative studies had subgroups with 1 participant, the single-participant subgroup was excluded. The treatment had to be in situ decompression with or without medial epicondylectomy or an anterior subcutaneous, subfascial, intramuscular, or submuscular transposition. The access could be open, minimally invasive, or endoscopic.
The primary outcome was response to treatment (ie, symptomatic improvement). The secondary outcomes were perioperative complications, reoperation, and recurrence.
The meta-analysis included a total of 30 studies of 2894 limbs undergoing 8 different operations.
Key findings of the study include:
- Overall, 87% of patients improved with surgery; all forms of in situ decompression were more effective than any type of transposition procedure; for example, open in situ decompression with epicondylectomy was associated with higher success rates than subcutaneous transposition (relative risk, 1.13).
- Postoperatively, 3% of patients developed complications, and in situ decompressions were ranked as the least risky, although there was considerable uncertainty in this outcome.
- Overall, 2% of patients required reoperation; open in situ decompression was associated with the fewest reoperations; in comparison, submuscular transposition was associated with 5 times the risk of reoperation (relative risk, 5.08).
- During surveillance, 3% of patients developed recurrence, and open in situ decompression with epicondylectomy was ranked as the safest operation, although there was uncertainty in the estimates.
"The findings of this study suggest that for adults with primary cubital tunnel syndrome, the most beneficial operation appears to be open in situ decompression," wrote the authors. "We suggest that future research focus on defining the disorder and generating core outcome measures before further (necessary) comparative studies are undertaken."
"Safety and Outcomes of Different Surgical Techniques for Cubital Tunnel Decompression: A Systematic Review and Network Meta-analysis," is published in JAMA Network Open.
DOI: https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2773396
