Article
Treatment for iatrogenic spinal accessory nerve injury by a part of ipsilateral posterior C7 root transfer
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Authors
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Yundong Shen
- Huashan Hospital, Fudan University, Jingan District Central Hospital, Shanghai, China
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Wendong Xu
- Huashan Hospital, Fudan University, Jingan District Central Hospital, Shanghai, China
| Published: | February 6, 2020 |
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Outline
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Objectives/Interrogation: Iatrogenic spinal accessory nerve (SAN) injury was one of serious operative complications of cervical lymph node biopsy, cystectomy or thyroid surgery. Comprehensive shoulder pain and weakness were common complaints, and even shoulder abduction paralysis. However, it was not always available to repair the SAN by nerve graft because of the proximal nerve retraction and local scar proliferation. Here an alternative method was introduced about a part of ipsilateral posterior C7 root transfer to repair SAN injury.
Methods: Six cases with iatrogenic SAN injury were included in this study. 4 cases were injured from cervical cystectomy, 1 cases from neck lymph node biopsy and 1 case from thyroidectomy. According to the previous anatomic study, the available fascicle length of posterior part of C7 root was long enough to be transposition to the distal end of SAN at susceptible site of injury. Also, an optimal route was designed for part of posterior C7 root transfer. All the operations of 6 cases were performed successfully, and the distal end of SAN was repaired by the C7 fascicle transfer directly without nerve graft. The results of recovery were recorded.
Results and Conclusions: The mean available length of the donor C7 nerve fascicle was 4.3 cm in 6 cases. Early signs of reinnervation of trapezius were observed by electrophysiological testing at 3 months after surgery in most cases, the latency was 7-8 ms, and improved to 6 ms at 6 months postoperatively. The results of electromyography (EMG) of the superior part of trapezius were a small number of nascent motor unit action potentials at 3 months postoperatively, which were about 3 months sooner than that in the middle and inferior parts of the muscle. Complex repetitive discharges were observed by EMG at 9 months to 1 year after surgery in all cases. The atrophic trapezius muscle preoperatively had visible signs of improvement from grade M0 to grade M3 at 6 months postoperatively and M4 strength at 12 months after surgery. The comprehensive shoulder pain was reduced greatly at 3 months after surgery in all cases and disappeared by the time of 6 months to 1 year.
The method of a part of ipsilateral posterior C7 root transfer to repair iatrogenic spinal accessory nerve injury was an effective alternative approach for those cases in which the proximal nerve of SAN could not be available duration operation.
