title: Spinal Accessory Nerve Monitoring and Clinical Outcome Results of Nerve-Sparing Neck Dissections.
abstract: To investigate the role of intraoperative spinal accessory nerve monitoring in predicting postoperative shoulder function in spinal accessory nerve-sparing neck dissections.
  
  
  
  Prospective, double-blind clinical trial.
  
  
  
  Academic, tertiary care center.
  
  
  
  This study was performed on 20 neck sites of 17 consecutive patients who had neck dissections sparing the spinal accessory nerve. Threshold increment ≥0.25 mA and amplitude decrement ≥72% were classified as significant intraoperative neuromonitoring changes while lesser differences were classified as insignificant intraoperative neuromonitoring changes. All patients had intraoperative neuromonitoring recordings when the spinal accessory nerve was first identified and at the end of surgery. Postoperative shoulder function was evaluated neurophysiologically with electromyography and clinically with Constant-Murley Score; daily activity restrictions were evaluated with Activity Restriction Scale.
  
  
  
  Clinical assessment of shoulder functions at postoperative first and second months showed statistically significant deteriorations when compared with preoperative values (P < .05). The shoulder function deterioration was statistically significantly less for patients with insignificant intraoperative neuromonitoring changes than patients with significant intraoperative neuromonitoring changes (P < .05). Daily activity restriction deteriorations were present in both groups at first postoperative month (P < .05). While they persisted in the group with significant intraoperative neuromonitoring changes during the second postoperative month (P < .05), there was continuing recovery in the insignificant intraoperative neuromonitoring change group and statistical significance disappeared (P > .05).
  
  
  
  Our results support the predictive value of spinal accessory nerve intraoperative neuromonitoring for determining shoulder function deterioration and activity restriction scores.
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Dokuz Eylul University Faculty of Medicine, Inciraltı, Izmir, Turkey.
authors.forename: Yucel
authors.initials: Y
authors.lastname: Birinci
authors.affiliation: School of Physical Therapy and Rehabilitation, Dokuz Eylul University, Inciraltı, Izmir, Turkey.
authors.forename: Arzu
authors.initials: A
authors.lastname: Genc
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Dokuz Eylul University Faculty of Medicine, Inciraltı, Izmir, Turkey.
authors.forename: Mustafa Cenk
authors.initials: MC
authors.lastname: Ecevit
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Dokuz Eylul University Faculty of Medicine, Inciraltı, Izmir, Turkey.
authors.forename: Taner Kemal
authors.initials: TK
authors.lastname: Erdag
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Dokuz Eylul University Faculty of Medicine, Inciraltı, Izmir, Turkey.
authors.forename: Enis Alpin
authors.initials: EA
authors.lastname: Guneri
authors.affiliation: Department of Neurology, Dokuz Eylul University Faculty of Medicine, Inciraltı, Izmir, Turkey.
authors.forename: Ibrahim
authors.initials: I
authors.lastname: Oztura
authors.affiliation: Department of Neurology, Dokuz Eylul University Faculty of Medicine, Inciraltı, Izmir, Turkey.
authors.forename: Ahmet
authors.initials: A
authors.lastname: Evlice
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Dokuz Eylul University Faculty of Medicine, Inciraltı, Izmir, Turkey ahmet.ikiz@deu.edu.tr.
authors.forename: Ahmet Omer
authors.initials: AO
authors.lastname: Ikiz
mesh_terms: D000055:Accessory Nerve; D000203:Activities of Daily Living; D004311:Double-Blind Method; D004576:Electromyography; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative / Q000379:methods*; D037981:Neck Dissection / Q000379:methods*; D011446:Prospective Studies; D012782:Shoulder / Q000294:innervation* / Q000503:physiopathology
keywords: accessory nerve; intraoperative; monitoring; neck dissection; shoulder