Injury to the spinal accessory nerve in the posterior cervical triangle
leads to paralysis of the trapezius muscle. The aim of this study was to
determine the indications for nerve repair or reconstructive surgery according
to the etiology, the duration of the preoperative delay, and specific patient
Of twenty-seven patients with a trapezius palsy, twenty were treated with
neurolysis or surgical repair (direct or with a graft) of the spinal accessory
nerve and seven were treated with the Eden-Lange muscle transfer procedure.
Lymph node biopsy was the main cause of the nerve injury. The nerve repairs
were performed at an average of seven months after the injury, and the
reconstructive procedures were done at an average of twenty-eight months.
Nerve repair was performed for iatrogenic injuries of the spinal accessory
nerve, within twenty months after the onset of symptoms, and in one patient
with spontaneous palsy. Reconstructive surgery was performed for cases of
trapezius palsy secondary to radical neck dissection, for spontaneous palsies,
and after failure of nerve repair or neurolysis. The mean follow-up period was
thirty-five months. The functional outcome was assessed clinically on the
basis of active shoulder abduction, pain, strength of the trapezius on manual
muscle-testing, and level of subjective patient satisfaction.
The results were good or excellent in sixteen of the twenty patients
treated with nerve repair and in four of the seven patients treated with the
Eden-Lange procedure. Poor results were seen in older patients and in patients
with a previous radical neck dissection.
Good results can be expected from a repair of the spinal accessory nerve if
it is performed within twenty months after the injury, as the nerve is
basically a purely motor nerve and the distance from the injury to the motor
end plates is short. Muscle transfer should be performed in patients with
spontaneous trapezius palsy, when previous nerve surgery has failed, or when
the time from the injury to treatment is over twenty months. Treatment is less
likely to succeed when the patient is older than fifty years of age or the
palsy was due to a radical neck dissection, penetrating injury, or spontaneous