Motor Innervation of the Trapezius by Cervical Sensitive Nerves: An Intraoperative Neuromonitoring Study and Postoperative Functional Outcomes.

IF 2.7 4区医学 Q2 HEALTH CARE SCIENCES & SERVICES

Healthcare Pub Date : 2025-09-13 DOI:10.3390/healthcare13182297

Enver Can Öncül, Ersoy Doğan, Aslı Çakir Çetin, Aybüke Cansu Kalkan, Seher Özyürek, Arzu Genç, Ahmet Ömer İkiz

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引用次数: 0

Abstract

Background/objectives: We investigated whether cervical sensitive nerves (CSN) provide motor input to the trapezius muscle and how this relates to short-term functional outcomes after neck dissection.

Methods: A total of 22 neck dissections were performed in 17 patients; the SAN was preserved. CSN roots (C2-C4) were stimulated intraoperatively using IONM. Shoulder and neck function were evaluated preoperatively and at 3 months in 15 operated necks using goniometry, an IMU-based motion analysis system (iSen), trapezius isometric strength, the Modified Constant-Murley Score (MCMS), and the Shoulder Pain and Disability Index (SPADI).

Results: CSN-evoked trapezius responses were detected in 10/22 (45.5%) dissections (C2: 6/22, 27.2%; C3: 4/22, 18.2%; C4: 0/22). Postoperatively, neck extension/rotation and shoulder abduction/external rotation decreased significantly within groups; upper and middle trapezius strength and MCMS also declined. Shoulder flexion loss was smaller when CSN motor participation was present. Median shoulder flexion (goniometry) changed from 162°→140° in CSN(+) vs. 170°→131° in CSN(-) (between-group p = 0.024). With iSen, shoulder flexion changed 120°→116° in CSN(+) vs. 122°→97° in CSN(-) (p = 0.033).

Conclusions: Approximately half of the neck dissections exhibited CSN-related motor responses. Short-term shoulder flexion was better preserved when CSN motor participation was present, suggesting that documenting CSN motor input intraoperatively may inform early rehabilitation planning.

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颈敏感神经支配斜方肌的运动神经：术中神经监测研究和术后功能结果。

背景/目的：我们研究了颈敏感神经（CSN）是否为斜方肌提供运动输入，以及这与颈部剥离后短期功能结果的关系。方法：17例患者共行22例颈部清扫术；SAN被保存了下来。术中使用IONM刺激CSN根（C2-C4）。术前和3个月时，对15例手术颈部的肩颈功能进行评估，采用角形测量法、基于imu的运动分析系统（iSen）、斜方肌等距强度、修正Constant-Murley评分（MCMS）和肩部疼痛和残疾指数（SPADI）。结果：ccn诱发的斜方肌反应在10/22（45.5%）个解剖中被检测到（C2: 6/22, 27.2%; C3: 4/22, 18.2%; C4: 0/22）。术后组内颈部伸展/旋转和肩部外展/外旋明显减少；上、中斜方肌力量和MCMS也有所下降。当CSN运动参与时，肩关节屈曲损失较小。CSN（+）的中位肩关节屈曲（角度）从162°→140°改变为CSN（-）的170°→131°（组间p = 0.024）。使用iSen后，CSN（+）组肩关节屈曲变化120°→116°，CSN（-）组肩关节屈曲变化122°→97°（p = 0.033）。结论：大约一半的颈部解剖表现出中枢神经网络相关的运动反应。当CSN运动参与时，短期肩关节屈曲得到了更好的保存，这表明术中记录CSN运动输入可以为早期康复计划提供信息。

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来源期刊

Healthcare Medicine-Health Policy

CiteScore

3.50

自引率

7.10%

发文量

审稿时长

47 days

期刊介绍： Healthcare (ISSN 2227-9032) is an international, peer-reviewed, open access journal (free for readers), which publishes original theoretical and empirical work in the interdisciplinary area of all aspects of medicine and health care research. Healthcare publishes Original Research Articles, Reviews, Case Reports, Research Notes and Short Communications. We encourage researchers to publish their experimental and theoretical results in as much detail as possible. For theoretical papers, full details of proofs must be provided so that the results can be checked; for experimental papers, full experimental details must be provided so that the results can be reproduced. Additionally, electronic files or software regarding the full details of the calculations, experimental procedure, etc., can be deposited along with the publication as “Supplementary Material”.