{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,3]],"date-time":"2026-11-03T11:02:42Z","timestamp":1793703762876,"version":"4.5.1"},"reference-count":95,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2018,5]]},"abstract":"<jats:sec>\n                    <jats:title>OBJECTIVE<\/jats:title>\n                    <jats:p>Ideal timeframes for operating on traumatic stretch and blunt brachial plexus injuries remain a topic of debate. Whereas on the one hand spontaneous recovery might occur, on the other hand, long delays are believed to result in poorer functional outcomes. The goal of this review is to assess the optimal timeframe for surgical intervention for traumatic brachial plexus injuries.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS<\/jats:title>\n                    <jats:p>A systematic search was performed in January 2017 in PubMed and Embase databases according to the PRISMA guidelines. Search terms related to \u201cbrachial plexus injury\u201d and \u201ctiming\u201d were used. Obstetric plexus palsies were excluded. Qualitative synthesis was performed on all studies. Timing of operation and motor outcome were collected from individual patient data. Patients were categorized into 5 delay groups (0\u20133, 3\u20136, 6\u20139, 9\u201312, and &gt; 12 months). Median delays were calculated for Medical Research Council (MRC) muscle grade \u2265 3 and \u2265 4 recoveries.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS<\/jats:title>\n                    <jats:p>Forty-three studies were included after full-text screening. Most articles showed significantly better motor outcome with delays to surgery less than 6 months, with some studies specifying even shorter delays. Pain and quality of life scores were also significantly better with shorter delays. Nerve reconstructions performed after long time intervals, even more than 12 months, can still be useful. All papers reporting individual-level patient data described a combined total of 569 patients; 65.5% of all patients underwent operations within 6 months and 27.4% within 3 months. The highest percentage of \u2265 MRC grade 3 (89.7%) was observed in the group operated on within 3 months. These percentages decreased with longer delays, with only 35.7% \u2265 MRC grade 3 with delays &gt; 12 months. A median delay of 4 months (IQR 3\u20136 months) was observed for a recovery of \u2265 MRC grade 3, compared with a median delay of 7 months (IQR 5\u201311 months) for \u2264 MRC grade 3 recovery.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSIONS<\/jats:title>\n                    <jats:p>The results of this systematic review show that in stretch and blunt injury of the brachial plexus, the optimal time to surgery is shorter than 6 months. In general, a 3-month delay appears to be appropriate because while recovery is better in those operated on earlier, this must be considered given the potential for spontaneous recovery.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3171\/2018.1.jns172068","type":"journal-article","created":{"date-parts":[[2018,6,1]],"date-time":"2018-06-01T09:59:47Z","timestamp":1527847187000},"page":"1-13","source":"Crossref","is-referenced-by-count":55,"title":["Timing of surgery in traumatic brachial plexus injury: a systematic review"],"prefix":"10.3171","author":[{"given":"Enrico","family":"Martin","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, University Medical Center Utrecht, The Netherlands; and"},{"name":"Computational Neuroscience Outcomes Center, Department of Neurosurgery, Brigham and Women\u2019s Hospital, Harvard Medical School, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joeky T.","family":"Senders","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University Medical Center Utrecht, The Netherlands; and"},{"name":"Computational Neuroscience Outcomes Center, Department of Neurosurgery, Brigham and Women\u2019s Hospital, Harvard Medical School, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aislyn C.","family":"DiRisio","sequence":"additional","affiliation":[{"name":"Computational Neuroscience Outcomes Center, Department of Neurosurgery, Brigham and Women\u2019s Hospital, Harvard Medical School, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Timothy R.","family":"Smith","sequence":"additional","affiliation":[{"name":"Computational Neuroscience Outcomes Center, Department of Neurosurgery, Brigham and Women\u2019s Hospital, Harvard Medical School, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marike L. D.","family":"Broekman","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University Medical Center Utrecht, The Netherlands; and"},{"name":"Computational Neuroscience Outcomes Center, Department of Neurosurgery, Brigham and Women\u2019s Hospital, Harvard Medical School, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"key":"b1","series-title":"Neurosurgery","first-page":"1016","article-title":"Functional outcome of brachial plexus reconstruction after trauma","volume":"61","author":"Ahmed-Labib M","year":"2007","unstructured":"Ahmed-Labib M, Golan JD, Jacques L: Functional outcome of brachial plexus reconstruction after trauma. Neurosurgery 61:1016\u20131023, 2007"},{"key":"b2","series-title":"J Neurosurg","first-page":"195","article-title":"Upper brachial plexus injury in adults: comparative effectiveness of different repair techniques","volume":"122","author":"Ali ZS","year":"2015","unstructured":"Ali ZS, Heuer GG, Faught RWF, Kaneriya SH, Sheikh UA, Syed IS, : Upper brachial plexus injury in adults: comparative effectiveness of different repair techniques. J Neurosurg 122:195\u2013201, 2015"},{"key":"b3","series-title":"Rev Chir Orthop Repar Appar Mot","first-page":"51","article-title":"[Paralysis of the brachial plexus caused by supraclavicular injuries in the adult. Long-term comparative results of nerve grafts and transfers.]","volume":"83","author":"Allieu Y","year":"1997","unstructured":"Allieu Y, Chammas M, Picot MC: [Paralysis of the brachial plexus caused by supraclavicular injuries in the adult. Long-term comparative results of nerve grafts and transfers.] Rev Chir Orthop Repar Appar Mot 83:51\u201359, 1997 (Fr)"},{"key":"b4","series-title":"Injury","first-page":"272","article-title":"Severe brachial plexus injuries in rugby","volume":"43","author":"Altaf F","year":"2012","unstructured":"Altaf F, Mannan K, Bharania P, Sewell MD, Di Mascio L, Sinisi M: Severe brachial plexus injuries in rugby. Injury 43:272\u2013273, 2012"},{"key":"b5","series-title":"Chir Main","first-page":"211","article-title":"[Recovery of elbow flexion in post-traumatic C5-C6 and C5-C6-C7 palsy: retrospective dual-center study comparing single and double nerve transfer.]","volume":"33","author":"Barthel PY","year":"2014","unstructured":"Barthel PY, Barbary S, Breton A, Apredoaei C, Dap F, Mansat P, : [Recovery of elbow flexion in post-traumatic C5-C6 and C5-C6-C7 palsy: retrospective dual-center study comparing single and double nerve transfer.] Chir Main 33:211\u2013218, 2014 (Fr)"},{"key":"b6","series-title":"Microsurgery","first-page":"311","article-title":"Primary nerve repair in associated lesions of the axillary artery and brachial plexus","volume":"26","author":"Battiston B","year":"2006","unstructured":"Battiston B, Bertoldo U, Tos P, Cimino F: Primary nerve repair in associated lesions of the axillary artery and brachial plexus. Microsurgery 26:311\u2013315, 2006"},{"key":"b7","series-title":"J Neurosurg","first-page":"365","article-title":"Surgical repair of brachial plexus injury: a multinational survey of experienced peripheral nerve surgeons","volume":"101","author":"Belzberg AJ","year":"2004","unstructured":"Belzberg AJ, Dorsi MJ, Storm PB, Moriarity JL: Surgical repair of brachial plexus injury: a multinational survey of experienced peripheral nerve surgeons. J Neurosurg 101:365\u2013376, 2004"},{"key":"b8","series-title":"J Bone Joint Surg Am","first-page":"20","article-title":"Complete traumatic brachial plexus palsy. Treatment and outcome after repair","volume":"81","author":"Bentolila V","year":"1999","unstructured":"Bentolila V, Nizard R, Bizot P, Sedel L: Complete traumatic brachial plexus palsy. Treatment and outcome after repair. J Bone Joint Surg Am 81:20\u201328, 1999"},{"key":"b9","series-title":"Microsurgery","first-page":"760","article-title":"Brachial plexus surgery: our concept of the last twelve years","volume":"15","author":"Berger A","year":"1994","unstructured":"Berger A, Becker MH: Brachial plexus surgery: our concept of the last twelve years. Microsurgery 15:760\u2013767, 1994"},{"key":"b10","series-title":"J Bone Joint Surg Br","first-page":"759","article-title":"Pain relief from preganglionic injury to the brachial plexus by late intercostal nerve transfer","volume":"78","author":"Berman J","year":"1996","unstructured":"Berman J, Anand P, Chen L, Taggart M, Birch R: Pain relief from preganglionic injury to the brachial plexus by late intercostal nerve transfer. J Bone Joint Surg Br 78:759\u2013760, 1996"},{"key":"b11","series-title":"Pain","first-page":"199","article-title":"Pain following human brachial plexus injury with spinal cord root avulsion and the effect of surgery","volume":"75","author":"Berman JS","year":"1998","unstructured":"Berman JS, Birch R, Anand P: Pain following human brachial plexus injury with spinal cord root avulsion and the effect of surgery. Pain 75:199\u2013207, 1998"},{"key":"b12","series-title":"Neurosurg Clin N Am","first-page":"15","article-title":"Brachial plexus injury: the London experience with supraclavicular traction lesions","volume":"20","author":"Birch R","year":"2009","unstructured":"Birch R: Brachial plexus injury: the London experience with supraclavicular traction lesions. Neurosurg Clin N Am 20:15\u201323, v, 2009"},{"key":"b13","series-title":"J Hand Surg Eur Vol","first-page":"562","article-title":"Timing of surgical reconstruction for closed traumatic injury to the supraclavicular brachial plexus","volume":"40","author":"Birch R","year":"2015","unstructured":"Birch R: Timing of surgical reconstruction for closed traumatic injury to the supraclavicular brachial plexus. J Hand Surg Eur Vol 40:562\u2013567, 2015"},{"key":"b14","series-title":"Neurosurg Clin N Am","first-page":"51","article-title":"Late reconstruction for brachial plexus injury","volume":"20","author":"Carlsen BT","year":"2009","unstructured":"Carlsen BT, Bishop AT, Shin AY: Late reconstruction for brachial plexus injury. 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J Hand Surg Am 22:605\u2013612, 1997"},{"key":"b17","series-title":"Indian J Plast Surg","first-page":"144","article-title":"Debates to personal conclusion in peripheral nerve injury and reconstruction: A 30-year experience at Chang Gung Memorial Hospital","volume":"49","author":"Chuang DCC","year":"2016","unstructured":"Chuang DCC: Debates to personal conclusion in peripheral nerve injury and reconstruction: A 30-year experience at Chang Gung Memorial Hospital. Indian J Plast Surg 49:144\u2013150, 2016"},{"key":"b18","series-title":"J Hand Surg Am","first-page":"285","article-title":"Functional restoration of elbow flexion in brachial plexus injuries: results in 167 patients (excluding obstetric brachial plexus injury)","volume":"18","author":"Chuang DCC","year":"1993","unstructured":"Chuang DCC, Epstein MD, Yeh MC, Wei FC: Functional restoration of elbow flexion in brachial plexus injuries: results in 167 patients (excluding obstetric brachial plexus injury). 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J Neurosci 15:3886\u20133895, 1995"},{"key":"b31","series-title":"J Neurosurg","first-page":"606","article-title":"Outcome after transfer of intercostal nerves to the nerve of triceps long head in 25 adult patients with total brachial plexus root avulsion injury","volume":"118","author":"Gao K","year":"2013","unstructured":"Gao K, Lao J, Zhao X, Gu Y: Outcome after transfer of intercostal nerves to the nerve of triceps long head in 25 adult patients with total brachial plexus root avulsion injury. J Neurosurg 118:606\u2013610, 2013"},{"key":"b32","series-title":"J Bone Joint Surg Am","first-page":"819","article-title":"Comparison of nerve transfers and nerve grafting for traumatic upper plexus palsy: a systematic review and analysis","volume":"93","author":"Garg R","year":"2011","unstructured":"Garg R, Merrell GA, Hillstrom HJ, Wolfe SW: Comparison of nerve transfers and nerve grafting for traumatic upper plexus palsy: a systematic review and analysis. J Bone Joint Surg Am 93:819\u2013829, 2011"},{"key":"b33","series-title":"J Hand Surg Am","first-page":"678","article-title":"Current concepts of the treatment of adult brachial plexus injuries","volume":"35","author":"Giuffre JL","year":"2010","unstructured":"Giuffre JL, Kakar S, Bishop AT, Spinner RJ, Shin AY: Current concepts of the treatment of adult brachial plexus injuries. J Hand Surg Am 35:678\u2013688, 2010 (Erratum in J Hand Surg Am 35:1226, 2010)"},{"key":"b34","series-title":"J Neurosci","first-page":"5325","article-title":"The basis for diminished functional recovery after delayed peripheral nerve repair","volume":"31","author":"Gordon T","year":"2011","unstructured":"Gordon T, Tyreman N, Raji MA: The basis for diminished functional recovery after delayed peripheral nerve repair. J Neurosci 31:5325\u20135334, 2011"},{"key":"b35","series-title":"Microsurgery","first-page":"7","article-title":"Reanimation of elbow extension with intercostal nerves transfers in total brachial plexus palsies","volume":"31","author":"Goubier JN","year":"2011","unstructured":"Goubier JN, Teboul F, Khalifa H: Reanimation of elbow extension with intercostal nerves transfers in total brachial plexus palsies. Microsurgery 31:7\u201311, 2011"},{"issue":"323","key":"b36","series-title":"Clin Orthop Relat Res","first-page":"119","article-title":"Use of the phrenic nerve for brachial plexus reconstruction","author":"Gu YD","year":"1996","unstructured":"Gu YD, Ma MK: Use of the phrenic nerve for brachial plexus reconstruction. Clin Orthop Relat Res (323):119\u2013121, 1996"},{"key":"b37","series-title":"Curr Opin Neurol","first-page":"570","article-title":"Repair and rehabilitation of plexus and root avulsions in animal models and patients","volume":"22","author":"Havton LA","year":"2009","unstructured":"Havton LA, Carlstedt T: Repair and rehabilitation of plexus and root avulsions in animal models and patients. Curr Opin Neurol 22:570\u2013574, 2009"},{"key":"b38","series-title":"J Hand Surg Eur Vol","first-page":"568","article-title":"Timing of surgical reconstruction for closed traumatic injury to the supraclavicular brachial plexus","volume":"40","author":"Hems TEJ","year":"2015","unstructured":"Hems TEJ: Timing of surgical reconstruction for closed traumatic injury to the supraclavicular brachial plexus. 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Clin Orthop Relat Res (147):210\u2013215, 1980"},{"key":"b41","series-title":"J Plast Reconstr Aesthet Surg","first-page":"472","article-title":"The influence of pre-surgical delay on functional outcome after reconstruction of brachial plexus injuries","volume":"62","author":"Jivan S","year":"2009","unstructured":"Jivan S, Kumar N, Wiberg M, Kay S: The influence of pre-surgical delay on functional outcome after reconstruction of brachial plexus injuries. J Plast Reconstr Aesthet Surg 62:472\u2013479, 2009"},{"key":"b42","series-title":"J Bone Joint Surg Br","first-page":"756","article-title":"The effects of operative delay on the relief of neuropathic pain after injury to the brachial plexus: a review of 148 cases","volume":"88","author":"Kato N","year":"2006","unstructured":"Kato N, Htut M, Taggart M, Carlstedt T, Birch R: The effects of operative delay on the relief of neuropathic pain after injury to the brachial plexus: a review of 148 cases. 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J Neurosurg 98:1005\u20131016, 2003"},{"key":"b45","series-title":"Neurosurg Clin N Am","first-page":"24","article-title":"Timing for brachial plexus injury: a personal experience","volume":"20","author":"Kline DG","year":"2009","unstructured":"Kline DG: Timing for brachial plexus injury: a personal experience. Neurosurg Clin N Am 20:24\u201326, v, 2009"},{"key":"b46","series-title":"J Neurosurg","first-page":"631","article-title":"Operative management of selected brachial plexus lesions","volume":"58","author":"Kline DG","year":"1983","unstructured":"Kline DG, Judice DJ: Operative management of selected brachial plexus lesions. J Neurosurg 58:631\u2013649, 1983"},{"key":"b47","series-title":"J Neurol Neurosurg Psychiatry","first-page":"188","article-title":"Nerve transfers and neurotization in peripheral nerve injury, from surgery to rehabilitation","volume":"87","author":"Korus L","year":"2016","unstructured":"Korus L, Ross DC, Doherty CD, Miller TA: Nerve transfers and neurotization in peripheral nerve injury, from surgery to rehabilitation. J Neurol Neurosurg Psychiatry 87:188\u2013197, 2016"},{"key":"b48","series-title":"J Neurosurg","first-page":"212","article-title":"Transfer of the phrenic nerve to the posterior division of the lower trunk to recover thumb and finger extension in brachial plexus palsy","volume":"114","author":"Lin H","year":"2011","unstructured":"Lin H, Hou C, Chen A, Xu Z: Transfer of the phrenic nerve to the posterior division of the lower trunk to recover thumb and finger extension in brachial plexus palsy. J Neurosurg 114:212\u2013216, 2011"},{"key":"b49","series-title":"Injury","first-page":"227","article-title":"Comparative study of phrenic nerve transfers with and without nerve graft for elbow flexion after global brachial plexus injury","volume":"45","author":"Liu Y","year":"2014","unstructured":"Liu Y, Lao J, Gao K, Gu Y, Zhao X: Comparative study of phrenic nerve transfers with and without nerve graft for elbow flexion after global brachial plexus injury. Injury 45:227\u2013231, 2014"},{"key":"b50","series-title":"Plast Reconstr Surg","first-page":"915","article-title":"Preliminary results of double nerve transfer to restore elbow flexion in upper type brachial plexus palsies","volume":"117","author":"Liverneaux PA","year":"2006","unstructured":"Liverneaux PA, Diaz LC, Beaulieu JY, Durand S, Oberlin C: Preliminary results of double nerve transfer to restore elbow flexion in upper type brachial plexus palsies. Plast Reconstr Surg 117:915\u2013919, 2006"},{"issue":"237","key":"b51","series-title":"Clin Orthop Relat Res","first-page":"32","article-title":"Emergency versus delayed repair of severe brachial plexus injuries","author":"Magalon G","year":"1988","unstructured":"Magalon G, Bordeaux J, Legre R, Aubert JP: Emergency versus delayed repair of severe brachial plexus injuries. Clin Orthop Relat Res (237):32\u201335, 1988"},{"key":"b52","series-title":"Neurol Med Chir (Tokyo)","first-page":"114","article-title":"Clinical analysis of 16 patients with brachial plexus injury","volume":"42","author":"Matsuyama T","year":"2002","unstructured":"Matsuyama T, Okuchi K, Akahane M, Inada Y, Murao Y: Clinical analysis of 16 patients with brachial plexus injury. 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