title: The evidence for nerve repair in obstetric brachial plexus palsy revisited.
abstract: Strong scientific validation for nerve reconstructive surgery in infants with Obstetric Brachial Plexus Palsy is lacking, as no randomized trial comparing surgical reconstruction versus conservative treatment has been performed. A systematic review of the literature was performed to identify studies that compare nerve reconstruction to conservative treatment, including neurolysis. Nine papers were identified that directly compared the two treatment modalities. Eight of these were classified as level 4 evidence and one as level 5 evidence. All nine papers were evaluated in detail to describe strong and weak points in the methodology, and the outcomes from all studies were presented. Pooling of data was not possible due to differences in patient selection for surgery and outcome measures. The general consensus is that nerve reconstruction is indicated when the result of nerve surgery is assumedly better than the expected natural recovery, when spontaneous recovery is absent or severely delayed. The papers differed in methodology on how the cut-off point to select infants for nerve reconstructive surgical therapy should be determined. The justification for nerve reconstruction is further discussed.
authors.affiliation: Department of Neurosurgery (J-11), Leiden University Medical Center, P.O. Box 9600, 2300 RC Leiden, The Netherlands.
authors.forename: Willem
authors.initials: W
authors.lastname: Pondaag
authors.affiliation: Department of Neurosurgery (J-11), Leiden University Medical Center, P.O. Box 9600, 2300 RC Leiden, The Netherlands.
authors.forename: Martijn J A
authors.initials: MJ
authors.lastname: Malessy
mesh_terms: D001917:Brachial Plexus / Q000473:pathology / Q000601:surgery*; D020516:Brachial Plexus Neuropathies / Q000473:pathology / Q000601:surgery*; D006801:Humans; D039781:PubMed; D016032:Randomized Controlled Trials as Topic; D019651:Plastic Surgery Procedures; D016896:Treatment Outcome