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Persistent Shoulder Dysfunction After Spinal Accessory Nerve-Preserving Neck Dissection: A Prospective Functional and

Borja A Bazán Inostroza¹, Jorge Prada Pendolero², Gustavo Eisenberg Plaza³

¹Department of ENT and Skull Base Surgery, Hospital Universitario de La Princesa, Madrid, Spain; Department of Medicine, Universidad Autónoma de Madrid, Madrid, Spain.

Acta Otorrinolaringologica Espanola

|July 3, 2026

Summary

Spinal accessory nerve dysfunction can occur after neck dissection despite nerve preservation. Early rehabilitation is crucial for patients experiencing persistent shoulder dysfunction and pain.

Keywords:

Disfunción del hombro Electromiografía Electromyography Head and neck cancer Intraoperative neuromonitoring Monitorización intraoperatoria Neck dissection Nervio espinal accesorio Neurophysiology Postoperative morbidity Shoulder dysfunction Spinal accessory nerve Vaciamiento cervical

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Area of Science:

Head and Neck Surgery
Neurology
Rehabilitation Medicine

Background:

Bilateral selective neck dissection (SNB) for head and neck cancers can impact shoulder function.
Spinal accessory nerve (SAN) preservation is crucial for maintaining shoulder mobility and strength.

Purpose of the Study:

To evaluate spinal accessory nerve (SAN) related shoulder dysfunction after nerve-preserving bilateral selective neck dissection.
To integrate objective functional, electromyographic, and patient-reported outcomes.

Main Methods:

Prospective cohort study of 26 patients undergoing bilateral selective neck dissection (levels II-IV).
Assessed shoulder range of motion (ROM), trapezius muscle electromyography (EMG), muscle strength, and patient-reported outcomes.
Intraoperative neuromonitoring with compound muscle action potential recording was utilized.

Main Results:

Significant reductions in shoulder abduction and flexion ROM persisted at 6 months post-surgery.
EMG amplitude decreased significantly at 1 month, with partial recovery by 6 months; latency increased transiently.
19.2% of patients experienced muscle strength deficits, and patient-reported disability increased significantly.

Conclusions:

Spinal accessory nerve (SAN) dysfunction can occur even with anatomical preservation and stable intraoperative monitoring.
Mechanisms like traction or perineural disruption at level IIB may cause neurapraxic changes.
Postoperative surveillance and early, targeted rehabilitation are essential for managing SAN dysfunction.