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BioMed Research International
Volume 2014 (2014), Article ID 434619, 11 pages
http://dx.doi.org/10.1155/2014/434619
Review Article

The Evidence for Nerve Repair in Obstetric Brachial Plexus Palsy Revisited

Department of Neurosurgery (J-11), Leiden University Medical Center, P.O. Box 9600, 2300 RC Leiden, The Netherlands

Received 12 October 2013; Accepted 2 November 2013; Published 16 January 2014

Academic Editor: Mohammad M. Al Qattan

Copyright © 2014 Willem Pondaag and Martijn J. A. Malessy. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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.