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Surgical Fasciectomy of the Trapezius Muscle Combined With Neurolysis of the Spinal Accessory Nerve; Results and Long-Term Follow-Up in 30 Consecutive Cases of Refractory Chronic Whiplash Syndrome

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Surgical Fasciectomy of the Trapezius Muscle Combined With Neurolysis of the Spinal Accessory Nerve; Results and Long-Term Follow-Up in 30 Consecutive Cases of Refractory Chronic Whiplash Syndrome

N Ake Nystrom et al. J Brachial Plex Peripher Nerve Inj.

Abstract

Background: Chronic problems from whiplash trauma generally include headache, pain and neck stiffness that may prove refractory to conservative treatment modalities. As has previously been reported, such afflicted patients may experience significant temporary relief with injections of local anesthetic to painful trigger points in muscles of the shoulder and neck, or lasting symptomatic improvement through surgical excision of myofascial trigger points. In a subset of patients who present with chronic whiplash syndrome, the clinical findings suggest an affliction of the spinal accessory nerve (CN XI, SAN) by entrapment under the fascia of the trapezius muscle. The present study was undertaken to assess the effectiveness of SAN neurolysis in chronic whiplash syndrome.

Methods: A standardized questionnaire and a linear visual-analogue scale graded 0-10 was used to assess disability related to five symptoms (pain, headache, insomnia, weakness, and stiffness) before, and one year after surgery in a series of thirty consecutive patients.

Results: The preoperative duration of symptoms ranged from seven months to 13 years. The following changes in disability scores were documented one year after surgery: Overall pain decreased from 9.5 +/- 0.9 to 3.2 +/- 2.6 (p < 0.001); headaches from 8.2 +/- 2.9 to 2.3 +/- 2.8 (p < 0.001); insomnia from 7.5 +/- 2.4 to 3.8 +/- 2.8 (p < 0.001); weakness from 7.6 +/- 2.6 to 3.6 +/- 2.8 (p < 0.001); and stiffness from 7.0 +/- 3.2 to 2.6 +/- 2.7 (p < 0.001).

Conclusions: Entrapment of the spinal accessory nerve and/or chronic compartment syndrome of the trapezius muscle may cause chronic debilitating pain after whiplash trauma, without radiological or electrodiagnostic evidence of injury. In such cases, surgical treatment may provide lasting relief.

Figures

Figure 1
Figure 1
Trajectory of the spinal accessory nerve in the posterior triangle (cadaveric dissection).
Figure 2
Figure 2
VAS-scores for global pain before (1) and one year after (2) surgery. n = 30.
Figure 3
Figure 3
Impairment caused by headache (VAS) at one-year follow-up relative to pre-surgical symptoms. 1 = No change; 2 = < 30% reduction; 3 = 30-49% reduction; 4 = 50-99% reduction; 5 = complete resolution. n = 27.

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