American Society for Peripheral Nerve

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Intraoperative Brief Electrical Stimulation For Prevention Of Shoulder Dysfunction After Oncologic Neck Dissection: A Double-Blinded Randomized Controlled Trial
Brittany Barber, MD; Matthew WT Curran, MD; Margaret McNeely, PT PhD; Rhys Beaudry, PT PhD; Jeffrey Harris, MD, MHA, FRCSC; Hadi Seikaly, MD, MAL, FRCSC; Jaret L. Olson, MD, K. Ming Chan, MD; Daniel O'Connell, MD, MSc, FRCSC
University of Alberta, Edmonton, AB, Canada

Introduction: Shoulder pain and dysfunction are common after head and neck cancer (HNC) surgery due to traction or compression injuries to the spinal accessory nerve (SAN). In addition to hindering postoperative rehabilitation and hygiene, this can negatively impact activities of daily living (ADLs) and return to work. Therefore, methods to accelerate recovery are much needed. Recently brief post surgical electrical stimulation (BES) was shown to enhance neuronal regeneration in patients with carpal tunnel syndrome and digital nerve laceration. The objective of this study is to test the hypothesis that post -surgical BES is effective in accelerating spinal accessory nerve regeneration and restoring shoulder function after oncologic neck dissection in HNC patients.

Methods & Methods: In this double blinded randomized controlled trial, adult participants with a new diagnosis of HNC undergoing surgery with neck dissection including Level IIb or V were enrolled. Patients were randomized to "BES" or "sham" in 1:1 allocation scheme. BES group participants underwent post-surgical BES after completion of neck dissection for 60 min at 20 Hz, 3-5 V of 0.1msec duration pulses to the spinal accessory nerve on the side with the most extensive nodal burden. Pre- and postoperatively, participants were evaluated by a blinded physiotherapist using the Constant-Murley Shoulder score (CMS). Secondary outcomes included nerve conduction studies (NCS) performed by a blinded neurophysiologist. Post-surgical outcomes were assessed at 6 and 12 months. Mann-Whitney and Chi-squared analyses were used for continuous and dichotomous values, respectively.

Results: Fifty-four patients were recruited. No differences in demographics, tumor characteristics, or neck dissection types were observed between groups. A significantly smaller change in CMS scores from baseline was observed in the BES group at 12 months, indicating better clinical preservation of shoulder function (p=0.022). . Change in NCS values were significantly smaller in the BES group at 12 months (p=0.048), indicating better neurophysiologic preservation of SAN function in the BES group.

Conclusion: Application of BES to the SAN after oncologic neck dissection objectively improves shoulder dysfunction after surgery. BES may be considered as a useful adjunct to postoperative shoulder rehabilitation in patients with HNC.

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