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Updated: May 31, 2025
Methods for In Vivo Biomechanical Testing on Brachial Plexus in Neonatal Piglets
Published on: December 19, 2019
Global trends in surgical approach to neonatal brachial plexus palsy: a systematic review
Michael F Levidy1, Amanda Azer1, Jasmine Shafei1
1Department of Orthopedic Surgery, Rutgers New Jersey Medical School, Newark, NJ, United States.
Insights
Age at brachial plexus birth injury (BPBI) surgery is increasing globally, with regional variations. Surgical approaches avoiding root exploration are becoming more common and are associated with older patient age.
Area of Science:
- Pediatric Surgery
- Neurosurgery
- Orthopedic Surgery
Background:
- Analyzed trends in age at surgery and surgical approach for brachial plexus birth injury (BPBI).
- Investigated geographical variations in surgical timing and technique.
Purpose of the Study:
- To assess temporal and geographical trends in the age of patients undergoing surgery for brachial plexus birth injuries.
- To evaluate the evolving landscape of surgical approaches, specifically exploration of the brachial plexus (EBP) versus nerve transfer without root exploration (NTwoRE).
Main Methods:
- Systematic review adhering to PRISMA-IPD guidelines, incorporating individual patient data.
- Categorization of surgical approaches into EBP (brachial plexus exploration) and NTwoRE (nerve transfer without root exploration).
- Regression analysis to identify trends in age at surgery and surgical approach from 1985-2020.
Main Results:
- Age at BPBI surgery has significantly increased between 1985 and 2020.
- Younger surgical ages were observed in Europe and Asia compared to North and South America.
- Nerve transfer without root exploration (NTwoRE) is increasing in incidence and was performed at a significantly older age than exploration of the brachial plexus (EBP).
Conclusions:
- Age at NBPP surgery is increasing, with notable regional differences.
- Surgical techniques avoiding brachial plexus root exploration are gaining popularity.
- The age of patients undergoing EBP is lower compared to those undergoing NTwoRE.
Background:
We analyzed trends in age at surgery and surgical approach over time and geography.
Methods:
We performed a systematic review according to PRISMA-IPD guidelines to include individual patient data. Collected data included age at surgery, location of surgery, and surgical approach. The surgical approach was independently categorized as the exploration of the brachial plexus (EBP) or nerve transfer without root exploration (NTwoRE). EBP was defined as exploring the brachial plexus in the supraclavicular fossa and applying a choice of coaptation procedures. NTwoRE included those sourcing donor nerves from, or entirely occurring outside of the plexus without exploring the root of the brachial plexus.
Results:
Regression analysis of age at surgery 1985-2020 showed that age at BPBI surgery is rising (p < 0.05). Surgery was performed at a younger age in patients from Europe (7.06 ± 7.77 months) and Asia (7.58 ± 5.33 months) than those from North America (10.44 ± 5.01 months) and South America (14.71 ± 4.53 months) (p < 0.05). NTwoRE was more common in North America (37%) and least common in Europe (12%). Age at EBP was 7.2 ± 5.77 months, and age at NTwoRE was 15.85 ± 13.18 months (p < 0.05). The incidence of NTwoRE is increasing time.
Conclusions:
Age at NBPP surgery is increasing over time. Regional differences exist in age at NBPP surgery. Approaches to NBPP surgery that avoid exploration of BP roots are becoming more popular. Age at EBP is lower than age at NTwoRE.
