{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,24]],"date-time":"2026-09-24T22:07:49Z","timestamp":1790287669870,"version":"4.1.0"},"reference-count":48,"publisher":"MDPI AG","issue":"18","license":[{"start":{"date-parts":[[2021,9,18]],"date-time":"2021-09-18T00:00:00Z","timestamp":1631923200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Lateral neck dissection (LND) leads to a significant morbidity involving accessory nerve injury. Modified radical neck dissection (MRND) aims at preservation of the accessory nerve, but patients often present with negative functional outcomes after surgery. The role of neuromonitoring (IONM) in the prevention of shoulder syndrome has not yet been defined in comparison to nerve visualization only. We retrospectively analyzed 56 thyroid cancer patients who underwent MRND over a period of six years (2015\u20132020) in a high-volume institution. Demographic variables, type of surgical procedure, removed lymph nodes and the metastatic node ratio, pathology, adoption of IONM and shoulder functional outcome were investigated. The mean number of lymph nodes removed was 15.61, with a metastatic node ratio of 0.2745. IONM was used in 41.07% of patients, with a prevalence of 68% in the period 2017\u20132020. IONM adoption showed an effect on post-operative shoulder function. There were no effects in 89.29% of cases, and temporary and permanent effects in 8.93% and 1.79%, respectively. Confidence intervals and two-sample tests for equality of proportions were used when applicable. Expertise in high-volume centres and IONM during MRND seem to be correlated with a reduced prevalence of accessory nerve lesions and limited functional impairments. These results need to be confirmed by larger prospective randomized controlled trials.<\/jats:p>","DOI":"10.3390\/jcm10184246","type":"journal-article","created":{"date-parts":[[2021,9,21]],"date-time":"2021-09-21T08:04:23Z","timestamp":1632211463000},"page":"4246","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":9,"title":["The Role of IONM in Reducing the Occurrence of Shoulder Syndrome Following Lateral Neck Dissection for Thyroid Cancer"],"prefix":"10.3390","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1319-1147","authenticated-orcid":false,"given":"Andrea","family":"Polistena","sequence":"first","affiliation":[{"name":"Endocrine Surgery, Santa Maria University Hospital, Perugia University, 05100 Terni, Italy"},{"name":"Department of Surgery Pietro Valdoni, Oncologic and Laparoscopic Surgery, Sapienza University of Rome, University Hospital Policlinico Umberto I, 00161 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Monia","family":"Ranalli","sequence":"additional","affiliation":[{"name":"Department of Statistical Sciences, Sapienza University of Rome, 00185 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stefano","family":"Avenia","sequence":"additional","affiliation":[{"name":"Residency Programme in General Surgery, Faculty of Medicine and Surgery, University of Perugia, 06123 Perugia, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Roberta","family":"Lucchini","sequence":"additional","affiliation":[{"name":"Endocrine Surgery, Santa Maria University Hospital, Perugia University, 05100 Terni, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alessandro","family":"Sanguinetti","sequence":"additional","affiliation":[{"name":"Endocrine Surgery, Santa Maria University Hospital, Perugia University, 05100 Terni, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sergio","family":"Galasse","sequence":"additional","affiliation":[{"name":"Endocrine Surgery, Santa Maria University Hospital, Perugia University, 05100 Terni, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fabio","family":"Rondelli","sequence":"additional","affiliation":[{"name":"Endocrine Surgery, Santa Maria University Hospital, Perugia University, 05100 Terni, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jacopo","family":"Vannucci","sequence":"additional","affiliation":[{"name":"Department of Surgery Paride Stefanini, Thoracic Surgery, Sapienza University of Rome, University Hospital Policlinico Umberto I, 00161 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6969-4157","authenticated-orcid":false,"given":"Renato","family":"Patrone","sequence":"additional","affiliation":[{"name":"PhD ICHT, University of Naples Federico II, 80131 Napoli, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3478-6270","authenticated-orcid":false,"given":"Nunzio","family":"Velotti","sequence":"additional","affiliation":[{"name":"Department of Advanced Biomedical Science, University of Naples Federico II, 80131 Naples, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giovanni","family":"Conzo","sequence":"additional","affiliation":[{"name":"Department of Traslational Medical Sciences, Division of General and Oncologic Surgery, University of Campania \u201cLuigi Vanvitelli\u201d, 80131 Naples, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicola","family":"Avenia","sequence":"additional","affiliation":[{"name":"Endocrine Surgery, Santa Maria University Hospital, Perugia University, 05100 Terni, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2021,9,18]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1089\/thy.2015.0020","article-title":"2015 American Thyroid Association Management Guidelines for Adult Patients with Thyroid Nodules and Differentiated Thyroid Cancer: The American Thyroid Association Guidelines Task Force on Thyroid Nodules and Differentiated Thyroid Cancer","volume":"26","author":"Haugen","year":"2016","journal-title":"Thyroid"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"2155","DOI":"10.1007\/s00268-021-06070-y","article-title":"The Clinical Significance of Lymph Node Ratio and Ki-67 Expression in Papillary Thyroid Cancer","volume":"45","author":"Lindfors","year":"2021","journal-title":"World J. 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