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Preoperative Evaluation of Iatrogenic Spinal Accessory Nerve Palsy

What Is the Place for Electrophysiological Testing?

Shen, Jun*; Ye, Xuan*; Qiu, Yanqun; Xu, Jing*; Zhu, Yi*; Shen, Yundong*; Xu, Wendong*,†,‡

Journal of Clinical Neurophysiology: July 2019 - Volume 36 - Issue 4 - p 306–311
doi: 10.1097/WNP.0000000000000589
Original Research
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Purpose: Electrophysiological testing has been used for the early diagnosis of iatrogenic spinal accessory nerve palsy in clinical practice. However, the presence of low-amplitude compound action potential in 70% to 90% of the patients suffering from iatrogenic nerve transection was reported in several studies. We have encountered the same issue and made minor modifications to the methods of electrophysiological testing. The purpose of this study was to retrospectively evaluate the reliability of our modified electrophysiological testing as preoperative examination in patients receiving surgical revision.

Methods: In this study, we compared preoperative electrophysiological testing results with intraoperative diagnosis in the 24 patients with iatrogenic spinal accessory nerve palsy who were referred to our hospital from 2009 to 2018.

Results: During operation, 20 patients were diagnosed with neurotmesis and the remaining 4 patients were found axonotmesis depending on the results of surgical exploration and intraoperative electrophysiological examination. Six of the 20 patients with neurotmesis demonstrated a low-amplitude compound muscle action potential of the upper trapezius during preoperative electrophysiological testing. Needle electromyography revealed voluntary motor unit potentials in 8 of the 20 patients. Meanwhile, concomitant great auricular nerve or dorsal scapular nerve injuries were preoperatively revealed in 7 of 24 patients.

Conclusions: The rate of low-amplitude compound muscle action potentials in these patients suffering from spinal accessory nerve neurotmesis was about 30% with our modified electrophysiological testing. We should be aware of this pitfall before surgical nerve repair. Furthermore, electrophysiological testing is an informative preoperative examination revealing the concomitant nerve injuries.

*Department of Hand Surgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China;

Department of Hand and Upper Extremity Surgery, Jing'an District Central Hospital, Shanghai, China; and

State Key Laboratory of Medical Neurobiology, Collaborative Innovation Center of Brain Science, Fudan University, Shanghai, China.

Address correspondence and reprint requests to Wendong Xu, MD, PhD, Department of Hand Surgery, Huashan Hospital, Shanghai Medical College, Fudan University, 12 Wulumuqi Middle Rd, Shanghai 200040, China; e-mail: wendongxu@fudan.edu.cn.

The authors have no funding or conflicts of interest to disclose.

J. Shen and X. Ye contributed equally to this work.

© 2019 by the American Clinical Neurophysiology Society