Intraoperative Temporary Electrical Stimulation of the Spinal Accent Nerve (BEST SPIN) for prevention of shoulder dysfunction after oncologic neck dissection: a double-blinded, randomized managed trial.
J Otolaryngol Head Neck Surg. 2018 Jan 23;47(1):7
Authors: Barber B, Seikaly H, Ming Chan Ok, Beaudry R, Rychlik S, Olson J, Curran M, Dziegielewski P, Biron V, Harris J, McNeely M, O’Connell D
BACKGROUND: Shoulder dysfunction is frequent after neck dissection for head and neck most cancers (HNC). Temporary electrical stimulation (BES) is a novel approach that has been proven to boost neuronal regeneration after nerve harm by modulating the brain-derived neurotrophic development issue (BDNF) pathways. The target of this examine was to judge the impact of BES on postoperative shoulder perform following oncologic neck dissection.
METHODS: Grownup contributors with a brand new prognosis of HNC present process Degree IIb +/- V neck dissection have been recruited. These within the therapy group obtained intraoperative BES utilized to the spinal accent nerve (SAN) after completion of neck dissection for 60 min of steady 20 Hz stimulation at Three-5 V of zero.1 msec balanced biphasic pulses, whereas these within the management group obtained no stimulation (NS). The first end result measured was the Fixed-Murley Shoulder (CMS) Rating, evaluating modifications from baseline to 12 months post-neck dissection. Secondary outcomes included the change within the Neck Dissection Impairment Index (?NDII) rating and the change in compound muscle motion potential amplitude (?CMAP) over the identical interval.
RESULTS: Fifty-four sufferers have been randomized to the therapy or management group with a 1:1 allocation scheme. No variations in demographics, tumor traits, or neck dissection varieties have been discovered between teams. Considerably decrease ?CMS scores have been noticed within the BES group at 12 months, indicating higher preservation of shoulder perform (p?=?zero.007). Solely 4 within the BES group in comparison with 17 sufferers within the NS teams noticed decreases higher than the minimally essential medical distinction (MICD) of the CMS (p?=?zero.zero23). Nonetheless, NDII scores (p?=?zero.089) and CMAP amplitudes (p?=?zero.067) between the teams didn’t attain statistical significance at 12 months. BES contributors with Degree IIb?+?V neck dissections had considerably higher ?CMS and ?CMAP scores at 12 months (p?=?zero.048 and p?=?zero.025, respectively).
CONCLUSIONS: Software of BES to the SAN might assist scale back impaired shoulder perform in sufferers present process oncologic neck dissection, and could also be thought-about a viable adjunct to practical rehabilitation therapies.
TRIAL REGISTRATION: Clinicaltrials.gov ( NCT02268344 , October 17, 2014).
PMID: 29361981 [PubMed – in process]