P86-T Iatrogenic spinal accessory nerve (SAN) injury

Abstract

SAN injury produces considerable disability. The most common cause is an inability to localize the nerve during neck surgeries. Recognizing the injury promptly is crucial for a better prognosis. We describe and analyze SAN injuries seen at our electromyography (EMG) laboratory during a period of four years. We present 6 cases of SAN injury; all of them because of iatrogenic damage during neck surgery. These surgeries did not proceed with intraoperative neurophysiological monitoring (IONM). The most common procedure was cervical lymphadenectomy (4 patients). The lapse of time since the damage until the first suspicion of neurogenic damage ranged from 0 to 7 months; only in 1 case the damage was detected in situ and in 2 patients after 7 months. We performed the first EMG 1 year after the injury in 3 patients; in the remaining 3 cases after 8, 4 and 2 months. None of our patients underwent reconstructive surgery. Their evolution was dissatisfactory: bad in 2 patients and very bad in 4. 3 patients suffered further musculoskeletal complications. 4 of our 6 patients worked before the SAN injury, 3 of whom were unable to work again. All the cases of SAN injury we saw during a period of four years were due to iatrogenic damage during neck surgeries – none of them were carried out with IONM. The diagnosis was late in most of our patients and this contributed to worsen the prognosis. IONM in these procedures would prevent injury and would allow early detection of the damage.