Results of reoperation for failed ulnar nerve surgery at the elbow: a systematic review and meta-analysis

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OBJECTIVE

The clinical results of reoperation for recurrent or persistent ulnar nerve compression at the elbow have not been clearly determined. The aim of this review was to determine overall improvement, residual pain, and sensory and motor deficits following reoperation regardless of the type of primary surgery performed for this condition.

METHODS

In accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) recommendations, a systematic review and meta-analysis of studies was performed. An independent librarian performed a literature search using Ovid MEDLINE, Embase, CINAHL, and the Cochrane Central Register of Controlled Trials (CENTRAL). The Newcastle-Ottawa Scale and the quality appraisal tool described by Moga et al. were used to assess the quality of included case series.

RESULTS

Of the 278 retrieved studies, 16 were eligible for analysis and included a total of 290 patients with failed surgery for ulnar nerve entrapment at the elbow. Relief of symptoms after reoperation was reported in 85% of patients. A decrease in pain was noted in 85% of the patients (95% CI 75%–93%). Only 2.4% of patients with preoperative pain experienced worse pain after reoperation. Motor and sensory function improvement was noted in 77% (95% CI 63%–88%) and 77% (95% CI 61%–90%) of cases, respectively. Complete recovery from signs and symptoms at the final follow-up was noted in 23% of elbows (95% CI 16%–31%).

CONCLUSIONS

Although the level of evidence of the included studies was low, the majority of patients had relief from their complaints after reoperation for recurrent or persistent ulnar nerve compression at the elbow following a previous surgery. The success rate of surgical treatment for a failed surgery was quite remarkable since almost a quarter of the patients completely recovered. Therefore, the authors recommend reoperation as a serious option for patients with this condition.

ABBREVIATIONS CENTRAL = Cochrane Central Register of Controlled Trials; STROBE = Strengthening the Reporting of Observational Studies in Epidemiology.

Article Information

Correspondence Tinatin Natroshvili: Radboud University Medical Center, Nijmegen, The Netherlands. tina_natroshvili@hotmail.com.

INCLUDE WHEN CITING Published online May 11, 2018; DOI: 10.3171/2017.8.JNS17927.

Disclosures The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper.

© AANS, except where prohibited by US copyright law.

Headings

Figures

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    Study identification process. N = number of studies; P = surgery for recurrent or persistent symptoms of ulnar nerve entrapment at the elbow after previous surgical treatment for ulnar nerve entrapment at the elbow.

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    Forest plot (A) and funnel plot (B) showing pooled results of overall symptomatic improvement in proportions of improved patients with 95% CIs per included study and table (C) indicating heterogeneity data.

  • View in gallery

    Forest plot (A) and funnel plot (B) showing pooled results of pain decrease in proportions of improved patients with 95% CIs per included study and table (C) indicating heterogeneity data.

  • View in gallery

    Forest plot (A) and funnel plot (B) showing pooled results of sensory improvement in proportions of improved patients with 95% CIs per included study and table (C) indicating heterogeneity data.

  • View in gallery

    Forest plot (A) and funnel plot (B) showing pooled results of improvement in motor function in proportions of improved patients with 95% CIs per included study and table (C) indicating heterogeneity data.

  • View in gallery

    Forest plot (A) and funnel plot (B) showing pooled results of complete recovery of signs and symptoms in proportions of improved patients with 95% CIs per included study and table (C) indicating heterogeneity data.

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