Surgical outcomes of 156 spinal accessory nerve injuries caused by lymph node biopsy procedures

Abstract

<jats:sec> <jats:title>OBJECT</jats:title> <jats:p>Iatrogenic injuries to the spinal accessory nerve (SAN) are not uncommon during lymph node biopsy of the posterior cervical triangle (PCT). In this study, the authors review the operative techniques and surgical outcomes of 156 surgical repairs of the SAN following iatrogenic injury during lymph node biopsy procedures.</jats:p></jats:sec> <jats:sec> <jats:title>METHODS</jats:title> <jats:p>This retrospective study examines the authors’ clinical and surgical experience with 156 patients with SAN injury between 1980 and 2012. All patients suffered iatrogenic SAN injuries during lymph node biopsy, with the vast majority (154/156, 98.7%) occurring in Zone I of the PCT. Surgery was performed on the basis of anatomical and electro-physiological findings at the time of the operation. The mean follow-up period was 24 months (range 8–44 months).</jats:p></jats:sec> <jats:sec> <jats:title>RESULTS</jats:title> <jats:p>Of the 123 patients who underwent graft or suture repair, 107 patients (87%) improved to Grade 3 functionality or higher using the Louisiana State University Health Science Center (LSUHSC) grading system. Neurolysis was performed in 29 patients (19%) when the nerve was found in continuity with recordable nerve action potential (NAP) across the lesion. More than 95% of patients treated by neurolysis with positive NAP recordings recovered to LSUHSC Grade 3 or higher. Forty-one patients (26%) underwent end-to-end repair, while 82 patients (53%) underwent graft repair, and Grade 3 or higher recovery was assessed for 90% and 85% of these patients, respectively. The average graft length used was 3.81 cm. Neurotization was performed in 4 patients, 2 of whom recovered to Grade 2 and 3, respectively.</jats:p></jats:sec> <jats:sec> <jats:title>CONCLUSIONS</jats:title> <jats:p>SAN injuries present challenges for surgical exploration and repair because of the nerve’s size and location in the PCT. However, through proper and timely intervention, patients with diminished or absent function achieved favorable functional outcomes. Surgeons performing lymph node biopsy procedures in Zone I of the PCT should be aware of the potential risk of injury to the SAN.</jats:p></jats:sec>

Ultrasound in the management of iatrogenic spinal accessory nerve palsy at the posterior cervical triangle area

“…Most iatrogenic SAN injuries are caused by operative procedures performed at the posterior cervical triangle (PCT) area. Approximately 80%–90% of patients with iatrogenic SAN palsy are diagnosed with neurotmesis by the Seddon classification . Early diagnosis and proper treatment are essential for prevention of lifelong disabilities.…”

Usefulness of ultrasonography for diagnosing iatrogenic spinal accessory nerve palsy after lymph node needle biopsy: a case report

“…During cervical surgery, it is always necessary to consider SAN injury. However, SAN damage is often not noticed immediately, and the diagnosis is delayed [ 2 , 3 ]. Early diagnosis and surgery within 3–6 months are recommended when improvement is poor [ 3 – 5 ].…”

Trapezius Palsy Resulting from Accessory Nerve Injury after Cervical Lymph Node Biopsy Dramatically Improved with Conservative Treatment

“…We propose the following criteria for conservative treatment for SAN injury after cervical lymph node biopsy. 1) The incision of the lymph node biopsy is more than one finger's breadth away from the course of the accessory nerve. 2) Some contraction of the upper fibers of the trapezius muscle is detected.…”

“…1) Microsurgical nerve repair, neurolysis, or nerve grafting, depending on the intraoperative nerve action potential, is reported to give good results. [1][2][3][4][5][6][7][8][9] However, once the nerve has been explored and pseudoneuroma has been found in the scar even though nerve continuity has been established, it is difficult to decide whether neurolysis will be sufficient to Background: Iatrogenic injuries to the spinal accessory nerve (SAN) are not uncommon during cervical lymph node biopsy. Many operative treatments for SAN injury in the posterior cervical triangle have been reported, but there are no guidelines regarding the choice between operative and nonoperative treatments.…”