Surgical Neuromodulation of Traumatic Brachial Plexus Injuries a Systematic Review and Meta-analysis

Med Arch, 2023 · DOI: 10.5455/medarh.2023.77.370-376 · Published: October 4, 2023

Simple Explanation

Traumatic brachial plexus injuries often lead to chronic pain syndromes, and conservative treatments are frequently insufficient. Spinal cord stimulation (SCS) is a neurosurgical technique used to manage this pain. This systematic review explores the use of cervical spinal cord stimulation as a neuromodulator for patients experiencing chronic pain after traumatic brachial plexus injury. SCS is a less invasive procedure with fewer neurological side effects, and a trial period is recommended before considering other neurosurgical interventions.

Study Duration

Follow-ups ranged from 1 month to 58 months

Participants

29 patients (8 case reports and 5 case series)

Evidence Level

Systematic Review and Meta-analysis of case reports and case series

Key Findings

1
86% of patients showed a good initial response to SCS, but the response decreased over time.
2
69% of patients reported a good response at the end of follow-up.
3
Lead migration was the only complication reported in two studies.

Research Summary

This systematic review and meta-analysis evaluated the use of spinal cord stimulation (SCS) for chronic pain management following traumatic brachial plexus injuries. The review included 13 studies (8 case reports and 5 case series) with a total of 29 patients. SCS showed a good initial response in most patients, but the response decreased over time. Lead migration was the primary complication reported.

Practical Implications

First-line treatment

SCS should be considered the first-line treatment for chronic pain after brachial plexus avulsion when conservative treatments fail.

High-frequency SCS

The benefits of SCS may be enhanced using high-frequency SCS as a first-line intervention.

Trial stimulation

A period of trial stimulation should be used in all patients before generator implantation.

Study Limitations

1
All studies reported here are retrospective and therefore suffer from inherent bias.
2
The follow-up period of many of these studies is less than two years.
3
There is wide heterogeneity across time and methodology between these studies.

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