Intraoperative Brief Electrical Stimulation of the Spinal Accessory Nerve (BEST SPIN) for prevention of shoulder dysfunction after oncologic neck dissection: a double-blinded, randomized controlled trial

Simple item page
dc.contributor.authorBarber, Brittany
dc.contributor.authorSeikaly, Hadi
dc.contributor.authorMing Chan, K.
dc.contributor.authorBeaudry, Rhys
dc.contributor.authorRychlik, Shannon
dc.contributor.authorOlson, Jaret
dc.contributor.authorCurran, Matthew
dc.contributor.authorDziegielewski, Peter
dc.contributor.authorBiron, Vincent
dc.contributor.authorHarris, Jeffrey
dc.contributor.authorMcNeely, Margaret
dc.contributor.authorO’Connell, Daniel
dc.date.accessioned2018-11-07T17:08:59Z
dc.date.available2018-11-07T17:08:59Z
dc.date.issued2018-01-23
dc.date.updated2018-11-07T17:08:59Z
dc.description.abstractAbstract Background 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. The objective of this study was to evaluate the effect of BES on postoperative shoulder function following oncologic neck dissection. Methods Adult 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. Results Fifty-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). Conclusions Application 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 registration Clinicaltrials.gov ( NCT02268344 , October 17, 2014).
dc.identifier.citationJournal of Otolaryngology - Head & Neck Surgery. 2018 Jan 23;47(1):7
dc.identifier.doihttps://doi.org/10.1186/s40463-017-0244-9
dc.identifier.urihttp://hdl.handle.net/1880/109085
dc.language.rfc3066en
dc.rights.holderThe Author(s).
dc.titleIntraoperative Brief Electrical Stimulation of the Spinal Accessory Nerve (BEST SPIN) for prevention of shoulder dysfunction after oncologic neck dissection: a double-blinded, randomized controlled trial
dc.typeJournal Article
Files
Original bundle
Now showing 1 - 1 of 1
Thumbnail Image
Name:
40463_2017_Article_244.pdf
Size:
1.25 MB
Format:
Adobe Portable Document Format
Description:
Download
License bundle
Now showing 1 - 1 of 1
Thumbnail Image
Name:
license.txt
Size:
0 B
Format:
Item-specific license agreed upon to submission
Description:
Download
Collections
Open Access Publications