Surgical Interventions for Lumbosacral Plexus Injuries: A Systematic Review

Area of Science:

• Neurosurgery
• Orthopedic Surgery
• Regenerative Medicine

Background:

• Lumbosacral plexus (LSP) injuries present varied surgical reconstruction challenges.
• Current treatment guidelines for LSP injuries are not well-defined.
• A comprehensive evaluation of surgical interventions for LSP injuries is lacking.

Purpose of the Study:

• To systematically review and consolidate existing literature on surgical interventions for LSP injuries.
• To present patient-reported and objective postoperative outcomes of these surgeries.

Main Methods:

• A systematic review was conducted across major scientific databases (PubMed, Embase, Web of Science, ProQuest, ClinicalTrials.gov).
• Studies were screened and selected based on predefined inclusion/exclusion criteria following PRISMA guidelines.
• Outcomes were analyzed based on injury location (femoral, obturator, sciatic, multilevel LSP) and surgical technique (neurolysis, direct repair, nerve graft, nerve transfer).

Main Results:

• 62 studies were included after reviewing 8683 potential citations.
• Nerve grafts and transfers showed success in improving functional and pain outcomes.
• Isolated femoral and obturator nerve injuries reported the best surgical outcomes.
• Incomplete sciatic and multilevel LSP injuries had more treatment options and better outcomes than complete sciatic nerve injuries.

Conclusions:

• Surgical techniques like nerve grafts and transfers offer viable options for LSP injury repair.
• Outcomes are contingent on injury location and surgical approach.
• Prompt surgical intervention for specific LSP injuries can lead to improved patient results.