PMID- 29361981 OWN - NLM STAT- MEDLINE DCOM- 20180831 LR - 20181113 IS - 1916-0216 (Electronic) IS - 1916-0208 (Print) IS - 1916-0208 (Linking) VI - 47 IP - 1 DP - 2018 Jan 23 TI - 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. PG - 7 LID - 10.1186/s40463-017-0244-9 [doi] LID - 7 AB - 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 (DeltaNDII) score and the change in compound muscle action potential amplitude (DeltaCMAP) 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 DeltaCMS 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 DeltaCMS and DeltaCMAP 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). FAU - Barber, Brittany AU - Barber B AD - Division of Otolaryngology-Head & Neck Surgery, University of Alberta, Edmonton, Canada. FAU - Seikaly, Hadi AU - Seikaly H AD - Division of Otolaryngology-Head & Neck Surgery, University of Alberta, Edmonton, Canada. FAU - Ming Chan, K AU - Ming Chan K AD - Department of Physical Rehabilitation Medicine, University of Alberta, Edmonton, Canada. FAU - Beaudry, Rhys AU - Beaudry R AD - Department of Physical Therapy, University of Texas, Arlington, Texas, USA. FAU - Rychlik, Shannon AU - Rychlik S AD - Division of Otolaryngology-Head & Neck Surgery, University of Alberta, Edmonton, Canada. FAU - Olson, Jaret AU - Olson J AD - Division of Plastic Surgery, University of Alberta, Edmonton, Canada. FAU - Curran, Matthew AU - Curran M AD - Division of Plastic Surgery, University of Alberta, Edmonton, Canada. FAU - Dziegielewski, Peter AU - Dziegielewski P AD - Department of Otolaryngology, University of Florida, Gainesville, FL, USA. FAU - Biron, Vincent AU - Biron V AD - Division of Otolaryngology-Head & Neck Surgery, University of Alberta, Edmonton, Canada. FAU - Harris, Jeffrey AU - Harris J AD - Division of Otolaryngology-Head & Neck Surgery, University of Alberta, Edmonton, Canada. FAU - McNeely, Margaret AU - McNeely M AD - Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Canada. FAU - O'Connell, Daniel AU - O'Connell D AD - Division of Otolaryngology-Head & Neck Surgery, University of Alberta, Edmonton, Canada. danoconnellmd@gmail.com. LA - eng SI - ClinicalTrials.gov/NCT02268344 GR - RES0021130/University Hospital Foundation/ PT - Journal Article PT - Randomized Controlled Trial DEP - 20180123 PL - England TA - J Otolaryngol Head Neck Surg JT - Journal of otolaryngology - head & neck surgery = Le Journal d'oto-rhino-laryngologie et de chirurgie cervico-faciale JID - 101479544 SB - IM MH - Accessory Nerve Injuries/etiology/*prevention & control MH - Adult MH - Aged MH - Canada MH - Double-Blind Method MH - Electric Stimulation/*methods MH - Female MH - Follow-Up Studies MH - Head and Neck Neoplasms/mortality/parasitology/*surgery MH - Humans MH - Intraoperative Care/methods MH - Male MH - Middle Aged MH - Neck Dissection/*adverse effects/methods MH - Range of Motion, Articular/physiology MH - Risk Assessment MH - Shoulder Joint/*physiopathology MH - Treatment Outcome PMC - PMC5781293 OTO - NOTNLM OT - Axonal regeneration OT - Electrical stimulation OT - Head neck cancer OT - Neck dissection OT - Nerve regeneration OT - Spinal accessory nerve COIS- ETHICS APPROVAL AND CONSENT TO PARTICIPATE: Institutional ethical approval was obtained from the Human Research Ethics Board (HREB) (Pro00046671) at the University of Alberta. CONSENT FOR PUBLICATION: All patients provided written informed consent prior to participation and provided consent for publication of data. COMPETING INTERESTS: DAO is a paid consultant for Medtronic Canada. The other authors declare that they have no competing interests. PUBLISHER'S NOTE: Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. EDAT- 2018/01/25 06:00 MHDA- 2018/09/01 06:00 PMCR- 2018/01/23 CRDT- 2018/01/25 06:00 PHST- 2017/02/02 00:00 [received] PHST- 2017/11/30 00:00 [accepted] PHST- 2018/01/25 06:00 [entrez] PHST- 2018/01/25 06:00 [pubmed] PHST- 2018/09/01 06:00 [medline] PHST- 2018/01/23 00:00 [pmc-release] AID - 10.1186/s40463-017-0244-9 [pii] AID - 244 [pii] AID - 10.1186/s40463-017-0244-9 [doi] PST - epublish SO - J Otolaryngol Head Neck Surg. 2018 Jan 23;47(1):7. doi: 10.1186/s40463-017-0244-9.