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There are several options of treatment when iatrogenic (i.e., caused by the surgeon) spinal accessory nerve damage is noted during surgery. For example, during a functional neck dissection that injures the spinal accessory nerve, injury prompts the surgeon to cautiously preserve branches of C2, C3, and C4 spinal nerves that provide supplemental innervation to the trapezius muscle. [3]
Bone morphogenetic protein (rhBMP) should not be routinely used in any type of anterior cervical spine fusion, such as with anterior cervical discectomy and fusion. [2] [3] There are reports of this therapy causing swelling of soft tissue which in turn can cause life-threatening complications due to difficulty swallowing and pressure on the respiratory tract.
Sensation, including pain and the sense of joint position (proprioception), travel via the ventral rami of the third (C3) and fourth (C4) cervical spinal nerves. [5] Since it is a muscle of the upper limb, the trapezius is not innervated by dorsal rami, despite being placed superficially in the back.
The nerve is intentionally removed in "radical" neck dissections, which are attempts at exploring the neck surgically for the presence and extent of cancer. Attempts are made to spare it in other forms of less aggressive dissection. [5] Injury to the accessory nerve can result in neck pain and weakness of the trapezius muscle.
Spinal fusion, also called spondylodesis or spondylosyndesis, is a surgery performed by orthopaedic surgeons or neurosurgeons that joins two or more vertebrae. [1] This procedure can be performed at any level in the spine (cervical, thoracic, lumbar, or sacral) and prevents any movement between the fused vertebrae.
Conservative treatment of craniocervical instability includes physical therapy [10] [11] [better source needed] and the use of a cervical collar to keep the neck stable. Cervical spinal fusion is performed on patients with more severe symptoms. [citation needed]