title: Intra-operative monitoring of the spinal accessory nerve: a systematic review.
abstract: OBJECTIVE
  To investigate evidence that intra-operative nerve monitoring of the spinal accessory nerve affects the prevalence of post-operative shoulder morbidity and predicts functional outcome.
  
  
  METHODS
  A search of the Medline, Scopus and Cochrane databases from 1995 to October 2012 was undertaken, using the search terms 'monitoring, intra-operative' and 'accessory nerve'. Articles were included if they pertained to intra-operative accessory nerve monitoring undertaken during neck dissection surgery and included a functional shoulder outcome measure. Further relevant articles were obtained by screening the reference lists of retrieved articles.
  
  
  RESULTS
  Only three articles met the inclusion criteria of the review. Two of these included studies suggesting that intra-operative nerve monitoring shows greater specificity than sensitivity in predicting post-operative shoulder dysfunction. Only one study, with a small sample size, assessed intra-operative nerve monitoring in neck dissection patients.
  
  
  CONCLUSIONS
  It is unclear whether intra-operative nerve monitoring is a useful tool for reducing the prevalence of accessory nerve injury and predicting post-operative functional shoulder outcome in patients undergoing neck dissection. Larger, randomised studies are required to determine whether such monitoring is a valuable surgical adjunct.
authors.affiliation: Physiotherapy Department,Calvary Mater Newcastle Hospital,NSW,Australia.
authors.forename: A C
authors.initials: AC
authors.lastname: McGarvey
authors.affiliation: School of Medicine and Public Health,Faculty of Health,University of Newcastle,Callaghan,Australia.
authors.forename: G R
authors.initials: GR
authors.lastname: Hoffman
authors.affiliation: School of Health Sciences,Faculty of Health,University of Newcastle,Callaghan,Australia.
authors.forename: P G
authors.initials: PG
authors.lastname: Osmotherly
authors.affiliation: School of Health Sciences,Faculty of Health,University of Newcastle,Callaghan,Australia.
authors.forename: P E
authors.initials: PE
authors.lastname: Chiarelli
mesh_terms: D000055:Accessory Nerve / Q000502:physiology*; D061227:Accessory Nerve Injuries / Q000517:prevention & control*; D006258:Head and Neck Neoplasms / Q000601:surgery*; D006801:Humans; D064795:Intraoperative Neurophysiological Monitoring; D018908:Muscle Weakness / Q000517:prevention & control; D037981:Neck Dissection / Q000009:adverse effects / Q000379:methods; D010146:Pain / Q000517:prevention & control; D011183:Postoperative Complications / Q000517:prevention & control*; D012782:Shoulder / Q000502:physiology