{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,24]],"date-time":"2026-09-24T22:42:20Z","timestamp":1790289740462,"version":"4.1.0"},"reference-count":20,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"4","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["SPI"],"published-print":{"date-parts":[[2015,10]]},"abstract":"<jats:sec>\n<jats:title>OBJECT<\/jats:title>\n<jats:p>Iatrogenic injuries to the spinal accessory nerve (SAN) are not uncommon during lymph node biopsy of the posterior cervical triangle (PCT). In this study, the authors review the operative techniques and surgical outcomes of 156 surgical repairs of the SAN following iatrogenic injury during lymph node biopsy procedures.<\/jats:p><\/jats:sec>\n<jats:sec>\n<jats:title>METHODS<\/jats:title>\n<jats:p>This retrospective study examines the authors\u2019 clinical and surgical experience with 156 patients with SAN injury between 1980 and 2012. All patients suffered iatrogenic SAN injuries during lymph node biopsy, with the vast majority (154\/156, 98.7%) occurring in Zone I of the PCT. Surgery was performed on the basis of anatomical and electro-physiological findings at the time of the operation. The mean follow-up period was 24 months (range 8\u201344 months).<\/jats:p><\/jats:sec>\n<jats:sec>\n<jats:title>RESULTS<\/jats:title>\n<jats:p>Of the 123 patients who underwent graft or suture repair, 107 patients (87%) improved to Grade 3 functionality or higher using the Louisiana State University Health Science Center (LSUHSC) grading system. Neurolysis was performed in 29 patients (19%) when the nerve was found in continuity with recordable nerve action potential (NAP) across the lesion. More than 95% of patients treated by neurolysis with positive NAP recordings recovered to LSUHSC Grade 3 or higher. Forty-one patients (26%) underwent end-to-end repair, while 82 patients (53%) underwent graft repair, and Grade 3 or higher recovery was assessed for 90% and 85% of these patients, respectively. The average graft length used was 3.81 cm. Neurotization was performed in 4 patients, 2 of whom recovered to Grade 2 and 3, respectively.<\/jats:p><\/jats:sec>\n<jats:sec>\n<jats:title>CONCLUSIONS<\/jats:title>\n<jats:p>SAN injuries present challenges for surgical exploration and repair because of the nerve\u2019s size and location in the PCT. However, through proper and timely intervention, patients with diminished or absent function achieved favorable functional outcomes. Surgeons performing lymph node biopsy procedures in Zone I of the PCT should be aware of the potential risk of injury to the SAN.<\/jats:p><\/jats:sec>","DOI":"10.3171\/2014.12.spine14968","type":"journal-article","created":{"date-parts":[[2015,6,26]],"date-time":"2015-06-26T14:06:06Z","timestamp":1435327566000},"page":"518-525","source":"Crossref","is-referenced-by-count":40,"title":["Surgical outcomes of 156 spinal accessory nerve injuries caused by lymph node biopsy procedures"],"prefix":"10.3171","volume":"23","author":[{"given":"Sang Hyun","family":"Park","sequence":"first","affiliation":[{"name":"Department of Anesthesiology and Pain Medicine, Jeju National University Medical School, Jeju, Korea;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yoshua","family":"Esquenazi","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, The University of Texas Health Science Center at Houston Medical School, Houston, Texas; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David G.","family":"Kline","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Louisiana State University Health Sciences Center, New Orleans, Louisiana"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel H.","family":"Kim","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, The University of Texas Health Science Center at Houston Medical School, Houston, Texas; and"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"key":"b1-spine14968","series-title":"Scand J Plast Reconstr Surg Hand Surg","doi-asserted-by":"publisher","first-page":"82","DOI":"10.1080\/02844310600836810","article-title":"Iatrogenic injury to the accessory nerve","volume":"41","author":"Bostr\u00f6m","year":"2007"},{"key":"b2-spine14968","series-title":"Head Neck","doi-asserted-by":"publisher","first-page":"1060","DOI":"10.1002\/hed.21495","article-title":"Neck treatment and shoulder morbidity: still a challenge","volume":"33","author":"Bradley","year":"2011"},{"key":"b3-spine14968","series-title":"J Bone Joint Surg Br","first-page":"62","article-title":"Injuries to the spinal accessory nerve: a lesson to surgeons","volume":"93","author":"Camp","year":"2011"},{"key":"b4-spine14968","series-title":"Clin Anat","doi-asserted-by":"publisher","first-page":"471","DOI":"10.1002\/ca.20796","article-title":"Anatomic landmarks for localization of the spinal accessory nerve","volume":"22","author":"Durazzo","year":"2009"},{"key":"b5-spine14968","series-title":"J Orthop Sports Phys Ther","doi-asserted-by":"publisher","first-page":"78","DOI":"10.2519\/jospt.2008.2454","article-title":"Spinal accessory nerve palsy: associated signs and symptoms","volume":"38","author":"Kelley","year":"2008"},{"key":"b6-spine14968","series-title":"Reg Anesth Pain Med","doi-asserted-by":"publisher","first-page":"174","DOI":"10.1097\/00115550-200703000-00022","article-title":"Course of the spinal accessory nerve relative to the brachial plexus","volume":"32","author":"Kessler","year":"2007"},{"key":"b7-spine14968","series-title":"Arch Surg","doi-asserted-by":"publisher","first-page":"1428","DOI":"10.1001\/archsurg.135.12.1428","article-title":"Surgical anatomy of the spinal accessory nerve and the trapezius branches of the cervical plexus","volume":"135","author":"Kierner","year":"2000"},{"key":"b8-spine14968","series-title":"Neurosurgery","doi-asserted-by":"publisher","first-page":"1106","DOI":"10.1227\/01.NEU.0000089058.82201.3D","article-title":"Surgical outcomes of 111 spinal accessory nerve injuries","volume":"53","author":"Kim","year":"2003"},{"key":"b9-spine14968","series-title":"J Laryngol Otol","doi-asserted-by":"publisher","first-page":"1118","DOI":"10.1017\/S0022215107000461","article-title":"Accessory nerve: anatomy and surgical identification","volume":"121","author":"Lloyd","year":"2007"},{"key":"b10-spine14968","series-title":"Ann R Coll Surg Engl","first-page":"146","article-title":"Iatrogenic accessory nerve injury","volume":"78","author":"London","year":"1996"},{"key":"b11-spine14968","series-title":"Curr Rev Musculoskelet Med","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1007\/s12178-007-9000-5","article-title":"Scapular winging: anatomical review, diagnosis, and treatments","volume":"1","author":"Martin","year":"2008"},{"key":"b12-spine14968","series-title":"Kline and Hudson\u2019s Nerve Injuries: Operative Results for Major Nerve Injuries, Entrapments, and Tumors","first-page":"391","article-title":"Accessory nerve","author":"Midha","year":"2008"},{"key":"b13-spine14968","series-title":"J Bone Joint Surg Am","doi-asserted-by":"publisher","first-page":"1616","DOI":"10.2106\/00004623-199811000-00007","article-title":"Iatrogenic injury of the spinal accessory nerve. 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