IATROGENIC INJURY OF THE SPINAL ACCESSORY NERVE - RESULTS OF REPAIR

We reviewed the results of repair of the spinal accessory nerve in sev en patients seen between September 1994 and January 1996, The nerve ha d been injured during biopsy of a cervical lymph node in six patients and during removal of a bullet in one. The average interval between th e time of the injury and the repair of the nerve was eight months (ran ge, three to fourteen months). An end-to-end repair of the nerve was p erformed in six patients, and a neurolysis was done in one. The averag e duration of follow-up was thirty-two months (range, twenty-four to t hirty-nine months). Postoperatively, all seven patients had relief of pain and stiffness in the shoulder girdle. Manual muscle-testing revea led normal strength of the trapezius, which was comparable,vith that o n the unaffected side. Four patients regained normal function of the s houlder. Three patients reported a stretching sensation or discomfort in the neck, periscapular discomfort, and fatigue of the extremity whe n lifting heavy objects or performing overhead activities. However, th ese residual symptoms were mild and tolerable and thus mere different in nature from the preoperative pain and stiffness. Iatrogenic injury of the spinal accessory nerve should be suspected if a patient has pai n or stiffness in the shoulder girdle and a history of a recent operat ion on the neck. The nerve should be explored if spontaneous recovery does not occur.