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

Background: Traumatic brachial plexus injuries are common among young adults, with a majority of patients succumbing to chronic pain syndromes. Conservative management is usually not satisfactory in these cases and surgical interventions are often required. We have conducted a systematic review and meta-analysis examining one of the neurosurgical techniques, spinal cord stimulation (SCS), in chronic pain neuromodulation in cases of chronic pain syndrome after traumatic brachial plexus injuries. Objective: This systematic review aims to explore the reported use of cervical spinal cord stimulation as a neuromodulator in patients with chronic pain syndromes following traumatic brachial plexus injury. Methods: A systematic literature search was conducted using MEDLINE through the OVID interface, ProQuest, Web of Science, The Cochrane Library, and Scopus. Our own files and reference lists of identified key articles were also searched. Results: A total of 13 studies (8 case reports and 5 case series), comprising 29 patients were included. Most brachial plexus injuries were sustained in motor vehicle accidents. 86% (25/29) of patients showed a good initial response to SCS, however, the response decreased over time, and 69% (20/29) of the patients reported a good response at the end of follow-up. Lead migration was the only complication reported in two studies. Conclusion: SCS is a less invasive procedure with significantly fewer neurological side effects. A trial period of SCS is suggested in patients who have failed conservative treatment modalities before other neurosurgical interventions are considered.