Pediatric Neurosurgery
Original Paper
A Systematic Review of Brachial Plexus Surgery for Birth-Related Brachial Plexus InjuryMcNeely P.D.a · Drake J.M.baDivision of Neurosurgery, Department of Surgery, QEII Health Sciences Centre, Dalhousie University, Halifax, N.S., bDivision of Neurosurgery, Department of Surgery, Hospital for Sick Children, University of Toronto, Toronto, Ont., Canada
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Article / Publication Details
Received: June 03, 2002
Accepted: September 06, 2002
Published online: January 20, 2003
Issue release date: February 2003
Number of Print Pages: 6
Number of Figures: 0
Number of Tables: 2
ISSN: 1016-2291 (Print)
eISSN: 1423-0305 (Online)
For additional information: https://www.karger.com/PNE
Abstract
Objective: Brachial plexus injury complicates 0.6–2.6 per 1,000 live births. Surgery is sometimes advocated for patients who fail to improve with conservative management. We reviewed the available literature on birth-related brachial plexus palsy in order to provide recommendations for surgical management, using evidence-based criteria. Methods: Studies were identified by searc hing Medline (1966–2002) and the Cochrane Library using the terms brachial plexus, neonate or infant, surgery and natural history. The reference lists of relevant articles were also reviewed. The search was restricted to articles published in English. Each article was classified according to its methodology. Management recommendations were suggested based on the results of the studies identified and the degree of certainty of the available literature. Results: Twenty-three papers were selected for detailed analysis. There are no randomized controlled trials that have investigated the role of brachial plexus surgery in the management of birth-related brachial plexus palsy. Two prospective studies of relevance were found, one describing the natural history of birth-related brachial plexus injury and one evaluating surgery for these patients. The remainder consisted of retrospective case series. Outcomes from surgical series are generally favorable (level III and V evidence). Direct comparison with the natural history could not be inferred from the series reviewed given the lack of controls. Conclusion: There is no conclusive evidence showing a benefit of surgery over conservative management approaches in the treatment of patients with birth-related brachial plexus injuries. Surgery remains a valid practice option given the level III and V evidence suggesting a possible benefit of surgery.
© 2003 S. Karger AG, Basel
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Article / Publication Details
Received: June 03, 2002
Accepted: September 06, 2002
Published online: January 20, 2003
Issue release date: February 2003
Number of Print Pages: 6
Number of Figures: 0
Number of Tables: 2
ISSN: 1016-2291 (Print)
eISSN: 1423-0305 (Online)
For additional information: https://www.karger.com/PNE
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