Abstract
BackgroundShoulder dysfunction is common after neck dissection for head and neck cancer (HNC). Brief electrical stimulation (BES) is a novel technique that has been shown to enhance neuronal regeneration after nerve injury by modulating the brain-derived neurotrophic growth factor (BDNF) pathways. The objective of this study was to evaluate the effect of BES on postoperative shoulder function following oncologic neck dissection.MethodsAdult participants with a new diagnosis of HNC undergoing Level IIb +/− V neck dissection were recruited. Those in the treatment group received intraoperative BES applied to the spinal accessory nerve (SAN) after completion of neck dissection for 60 min of continuous 20 Hz stimulation at 3-5 V of 0.1 msec balanced biphasic pulses, while those in the control group received no stimulation (NS). The primary outcome measured was the Constant-Murley Shoulder (CMS) Score, comparing changes from baseline to 12 months post-neck dissection. Secondary outcomes included the change in the Neck Dissection Impairment Index (ΔNDII) score and the change in compound muscle action potential amplitude (ΔCMAP) over the same period.ResultsFifty-four patients were randomized to the treatment or control group with a 1:1 allocation scheme. No differences in demographics, tumor characteristics, or neck dissection types were found between groups. Significantly lower ΔCMS scores were observed in the BES group at 12 months, indicating better preservation of shoulder function (p = 0.007). Only four in the BES group compared to 17 patients in the NS groups saw decreases greater than the minimally important clinical difference (MICD) of the CMS (p = 0.023). However, NDII scores (p = 0.089) and CMAP amplitudes (p = 0.067) between the groups did not reach statistical significance at 12 months. BES participants with Level IIb + V neck dissections had significantly better ΔCMS and ΔCMAP scores at 12 months (p = 0.048 and p = 0.025, respectively).ConclusionsApplication of BES to the SAN may help reduce impaired shoulder function in patients undergoing oncologic neck dissection, and may be considered a viable adjunct to functional rehabilitation therapies.Trial registrationClinicaltrials.gov (NCT02268344, October 17, 2014).
Highlights
Shoulder dysfunction is common after neck dissection for head and neck cancer (HNC)
Between October 6, 2014 and June 6, 2015, 68 participants were assessed for inclusion in the trial
Mean follow-up was 257.7 days for all patients, 254.7 for the Brief electrical stimulation (BES) group and 260.5 days for the no stimulation (NS) group
Summary
Shoulder dysfunction is common after neck dissection for head and neck cancer (HNC). Brief electrical stimulation (BES) is a novel technique that has been shown to enhance neuronal regeneration after nerve injury by modulating the brain-derived neurotrophic growth factor (BDNF) pathways. Head and neck cancer (HNC) commonly presents in the third and fourth decade of life. Treatment choices in this cancer patient population should consider the potential for many remaining working years [1, 2]. The superior 5 cm of the SAN is often completely devascularized in a Level IIb dissection in order to skeletonize all lymphatic tissues off the nerve [5]. Devascularization and retraction of the SAN can result in axonal injury, which can give rise to shoulder pain and dysfunction postoperatively, even in nerve-sparing procedures [6]. Shoulder pain and dysfunction from SAN injury has pronounced and well-documented negative effects on quality of life [7]. As the majority of HNC patients are still of working age, the potential ramifications of shoulder dysfunction may result in longstanding socioeconomic consequences [8]
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More From: Journal of Otolaryngology - Head & Neck Surgery
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