Patients With Seizure Disorders Undergoing Surgery for Recurrent Anterior Shoulder Instability Show Variable Rates of Recurrence With Seizures as the Most Common Cause of Failure: A Systematic Review

Abstract

Purpose

To evaluate postoperative outcomes of patients with seizure disorder undergoing stabilization surgery for the treatment of recurrent anterior shoulder instability.

Methods

PubMed, Cochrane Center for Register of Controlled Trials (Cochrane Center for Register of Controlled Trials), and Scopus were searched in January 2024 for articles using the Preferred Reporting Items for Systematic Reviews and Meta-analyses criteria. Articles were included if they evaluated postoperative functional, clinical, or recurrence/reoperation outcomes after surgical stabilization in patients with a history of seizures and recurrent anterior shoulder instability. For postoperative outcomes reported in 3 or more studies with mean and standard deviation, forest plots were generated, and I² was calculated.

Results

A total of 8 studies were included: 7 studies focused on the Latarjet or other bone block augmentation procedures and 1 study focused on a soft tissue-only stabilization procedure. There were a total of 157 Latarjet or bone block augmentation surgeries (143 patients: 124 male [86.7%], 19 female [13.3%]) and 29 soft tissue−only stabilization surgeries (27 patients: 23 male [85.2%], 4 female [14.8%]). Recurrent dislocation or subluxation rates ranged from 0% to 43%. Of the 5 studies that reported the cause of postoperative dislocation or instability, 4 identified seizures as the cause of all cases. In studies comparing Latarjet outcomes between patients with versus without seizure disorders, instability recurrence ranged from 1.8% to 9.5% in the nonseizure group and from 9% to 40% in the seizure group.

Conclusions

The recurrence of anterior shoulder instability after surgical stabilization in patients with seizure disorders was variable across studies, ranging from 0% to 43%. Seizure was the most common reported cause for recurrent instability after surgery.

Level of Evidence

Level IV, systematic review of Level III and IV studies.