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Preoperative ultrasound accurately characterizes surgically confirmed extracranial spinal accessory nerve injuries

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Abstract

Objective

To determine the accuracy of preoperative ultrasound and MRI in surgically confirmed spinal accessory nerve injuries and present the benefits of a multimodality image review.

Materials and methods

A retrospective review of 38 consecutive patients referred to a peripheral nerve surgical practice at an academic teaching hospital with surgically confirmed spinal accessory nerve injuries. All cases were reviewed for patient demographics, date and cause of injury, preoperative EMG, and surgical diagnosis and management. Additionally, prospective interpretation of preoperative ultrasound and MRI reports were reviewed for concordance or discordance with the surgical diagnosis.

Results

Iatrogenic injury was present in 37 (97%) cases and most commonly a result of an excisional lymph node biopsy (68%). Surgically confirmed spinal accessory nerve injury diagnoses consisted of 25 (66%) stump neuromas and 13 (34%) incomplete nerve injuries. Nine months was the average time from injury to surgery. Twenty-nine patients underwent preoperative ultrasound and/or MRI evaluation: 12 ultrasound only, 10 MRI only, and seven with both ultrasound and MRI. Eighteen (95%) preoperative ultrasound reports compared to four (24%) preoperative MRI reports were concordant with the surgical diagnosis. In the seven cases with both preoperative ultrasound and MRI, six had discordant ultrasound and MRI imaging diagnoses for which the ultrasound was concordant with the surgical diagnoses in all cases.

Conclusion

Preoperative ultrasound more accurately characterizes spinal accessory nerve injuries compared to MRI and should serve as the modality of choice when a spinal accessory nerve injury is suspected.

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Acknowledgements

The authors thank Desiree J. Lanzino, PT, PhD, for her help in editing the manuscript.

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Authors and Affiliations

  1. Division of Musculoskeletal Imaging, Department of Radiology, Mayo Clinic, 200 1st St. SW, Rochester, MN, 55905, USA

    Garret M. Powell, Francis I. Baffour, Amanda M. Baillargeon & Katrina N. Glazebrook

  2. Department of Neurological Surgery, Mayo Clinic, Rochester, MN, USA

    Robert J. Spinner

Authors
  1. Garret M. Powell
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  2. Francis I. Baffour
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  3. Amanda M. Baillargeon
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  4. Robert J. Spinner
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  5. Katrina N. Glazebrook
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Correspondence to Katrina N. Glazebrook.

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Powell, G.M., Baffour, F.I., Baillargeon, A.M. et al. Preoperative ultrasound accurately characterizes surgically confirmed extracranial spinal accessory nerve injuries. Skeletal Radiol 51, 1179–1188 (2022). https://doi.org/10.1007/s00256-021-03945-y

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  • DOI: https://doi.org/10.1007/s00256-021-03945-y

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