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Clinical outcomes report in different brachial plexus injury surgeries: a systematic review

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Abstract

Brachial plexus injury is a lesion that results in loss of function of the arm, and there are multiple ways of surgically approaching its treatment. Controlled trials that compare all surgical repair strategies and their clinical outcomes have not been performed. A systematic review was conducted to identify all articles that reported clinical outcomes in different surgeries (nerve transfer, nerve graft, neurolysis, end-to-end, multiple interventions, and others). Advanced search in PubMed was performed using the Mesh terms “brachial plexus injury” as the main topic and “surgery” as a subtopic, obtaining a total of 2153 articles. The clinical data for eligibility extraction was focused on collecting motor, sensory, pain, and functional recovery. A statistical analysis was performed to find the superior surgical techniques in terms of motor recovery, through the assessment of heterogeneity between groups, and of relationships between surgery and motor recovery. The frequency and the manner in which clinical outcomes are recording were described. The differences that correspond to the demographics and procedural factors were not statistically significant among groups (p > 0.05). Neurolysis showed the highest proportion of motor recovery (85.18%), with significant results between preoperative and post-operative motor assessment (p = 0.028). The proportion of motor recovery in each group according to the surgical approach differed significantly (X2 = 82.495, p = 0.0001). The motor outcome was the most reported clinical outcome (97.56%), whereas the other clinical outcomes were reported in less than 15% of the included articles. Unexpectedly, neurolysis, a technique displaced by new surgical alternatives such as nerve transfer/graft, demonstrated the highest proportion of motor recovery. Clinical outcomes such as pain, sensory, and functional recovery were infrequently reported. These results introduce the need to re-evaluate neurolysis through comparative clinical trials, as well as to standardize the way in which clinical outcomes are reported.

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Data Availability

The datasets generated during the present study are available from the corresponding author on reasonable request.

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Author information

Authors and Affiliations

  1. Mexican Faculty of Medicine, La Salle University, Mexico City, Mexico

    A. Armas-Salazar

  2. Functional & Stereotactic Neurosurgery & Radiosurgery Service, General Hospital of Mexico, Doctor Balmis 148 Doctores, México City, 06720, México

    A. Armas-Salazar, A. I. García-Jerónimo, F. A. Villegas-López, J. L. Navarro-Olvera & J. D. Carrillo-Ruiz

  3. Research Direction of General Hospital of Mexico, Mexico City, Mexico

    J. D. Carrillo-Ruiz

  4. Faculty of Health Sciences Direction, of Anahuac University Mexico, Mexico City, Mexico

    J. D. Carrillo-Ruiz

Authors
  1. A. Armas-Salazar
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  2. A. I. García-Jerónimo
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  3. F. A. Villegas-López
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  4. J. L. Navarro-Olvera
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Contributions

Armas-Salazar and García-Jeronimo wrote the manuscript with support from Villegas-Lopez. Carrillo-Ruiz and Armas-Salazar conceived the idea. Armas-Salazar, Garcia-Jeronimo, and Navarro-Olvera performed the analyses and measurements. Armas-Salazar, Carrillo-Ruiz, Navarro-Olvera, and Villegas-Lopez verified the analytical methods and contributed to the interpretation of the results. Carrillo-Ruiz supervised the project. All authors discussed the results and contributed to the final manuscript.

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Correspondence to J. D. Carrillo-Ruiz.

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Armas-Salazar, A., García-Jerónimo, A.I., Villegas-López, F.A. et al. Clinical outcomes report in different brachial plexus injury surgeries: a systematic review. Neurosurg Rev 45, 411–419 (2022). https://doi.org/10.1007/s10143-021-01574-6

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  • DOI: https://doi.org/10.1007/s10143-021-01574-6

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