Surgical Interventions for Lumbosacral Plexus Injuries: A Systematic Review

David Spencer Nichols; Jesse Fenton; Elizabeth Cox; Jonathan Dang; Anna Garbuzov; Patti McCall-Wright; Harvey Chim

doi:10.1097/GOX.0000000000004436

Surgical Interventions for Lumbosacral Plexus Injuries: A Systematic Review

Plast Reconstr Surg Glob Open. 2022 Aug 24;10(8):e4436. doi: 10.1097/GOX.0000000000004436. eCollection 2022 Aug.

Authors

David Spencer Nichols¹, Jesse Fenton¹, Elizabeth Cox¹, Jonathan Dang², Anna Garbuzov³, Patti McCall-Wright⁴, Harvey Chim²

Affiliations

¹ College of Medicine, University of Florida, Gainesville, Fla.
² Division of Plastic and Reconstructive Surgery, University of Florida College of Medicine, Gainesville, Fla.
³ University of Queensland-Ochsner Clinical School, New Orleans, La.
⁴ Academic and Research Consulting, George A. Smathers Libraries, University of Florida, Gainesville, Fla.

Abstract

Background: Nerve reconstruction techniques for lumbosacral plexus (LSP) injuries vary. There are no clear treatment guidelines available, and summative evaluations of the literature discussing these surgeries are lacking. For these reasons, this investigation aimed to systematically review and consolidate all available literature discussing surgical interventions for LSP injuries and cohesively present patient-reported and objective postoperative outcomes.

Methods: The authors conducted a systematic review using PubMed, Embase, Web of Science, ProQuest Dissertations and Theses Global (via Proquest.com), and ClinicalTrials.gov databases according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. After title and abstract screening, identified articles were read in full and selected for inclusion based on prespecified criteria.

Results: Our literature search identified 8683 potential citations, and after duplicate removal, abstract screening, and full-text review, 62 studies remained meeting inclusion and exclusion criteria. Outcomes were extracted according to the location of injury and type of surgical repair. Injuries were classified into isolated femoral nerve injuries, isolated obturator nerve injuries, isolated sciatic nerve injuries, and multilevel LSP injuries. Surgical treatment was further classified into exploration with neurolysis, direct repair, nerve grafting, and nerve transfer surgery.

Conclusions: Although results vary based on the location of the injury and the surgical technique used, nerve grafts and transfers demonstrated reasonable success in improving functional and pain outcomes. Overall, isolated femoral and obturator nerve injuries had the best outcomes reported with surgical treatment. Furthermore, incomplete sciatic nerve and multilevel LSP injuries had more reported surgical options and better outcomes than complete sciatic nerve injuries.