Robin Babadjouni, MD: No financial relationships to disclose
Introduction: Closed, high sciatic nerve injuries can be a devastating consequence of surgical positioning and/or orthopedic procedures. These injuries are poorly understood, debilitating, and potentially permanent. The purpose of this study is to perform a systematic review of the literature to better understand the natural history for functional recovery, including the pattern, degree, and timeframe for doing so.
Methods: A systematic review was performed following PRISMA guidelines to identify studies reporting closed, high sciatic nerve injuries related to surgical positioning and/or intraoperative traction. Data regarding postoperative recovery was collected. Studies not commenting on muscle strength were excluded.
Results: Twenty-three studies met inclusion criteria (110 patients, 115 sciatic nerves). Of these, 49.5% nerves recovered fully while 46.9% had partial or no recovery. Seven (30.4%) studies described muscle strength using objective measures, 6 using the BMRC scoring system. Five (21.7%) studies did not specify a postoperative time period. While no studies reported on specific recovery of the tibial versus peroneal branches, one (4.3%) study provided enough objective data over time to deduce this information.
Conclusion : There is limited and inconsistent functional data in the literature to draw any meaningful conclusions about the natural history of closed, high sciatic nerve injuries. Future studies that follow muscle strength scores over time can provide a better understanding of the permanence of these injuries and help guide treatment decisions.
