Age as a Predictor of Long-Term Results in Patients with Brachial Plexus Palsies Undergoing Surgical Repair.
Socolovsky, Mariano MD, PhD 1; di Masi, Gilda MD 1; Bonilla, Gonzalo MD 1; Lovaglio, Ana Carolina MD 1; Lopez, Dan MD 2
15(1):15-24, July 2018.
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BACKGROUND: Among other factors, like the time from trauma to surgery or the number of axons that reach the muscle target, a patient's age might also impact the final results of brachial plexus surgery.
OBJECTIVE: To identify (1) any correlations between age and the 2 outcomes: elbow flexion strength and shoulder abduction range; (2) whether childhood vs adulthood influences outcomes; and (3) other baseline variables associated with surgical outcomes.
METHODS: Twenty pediatric patients (under age 20 yr) who had sustained a traumatic brachial plexus injury were compared against 20 patients, 20 to 29 yr old, and 20 patients, 30 yr old or older. Univariate, univariate trend, and correlation analyses were conducted with patient age, time to surgery, type of injury, and number of injured roots included as independent variables.
RESULTS: A statistically significant trend toward decreasing mean strength in elbow flexion, progressing from the youngest to oldest age group, was observed. This linear trend persisted when subjects were subdivided into 4 age groups (<20, 20-29, 30-39, >=40). There were no differences by age group in final shoulder abduction range or the percentage achieving a good shoulder outcome.
CONCLUSION: Our data suggest that age is somehow linked to the outcomes of brachial plexus surgery with respect to elbow flexion, but not shoulder abduction strength. Increasing age is associated with steadily worsening elbow flexion outcomes, perhaps indicating the need for earlier surgery and/or more aggressive repairs in older patients.
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