Tinatin Natroshvili May 12, 2018

Journal of Neurosurgery, Ahead of Print.
OBJECTIVEThe 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.METHODSIn 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.RESULTSOf 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%).CONCLUSIONSAlthough 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.


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