An anatomic-based approach to the iatrogenic spinal accessory nerve injury in the posterior cervical triangle: How to avoid and treat it

Iatrogenic injury of the spinal accessory nerve (SAN) is a significant reducible risk with any invasive procedure involving the posterior cervical triangle. Most commonly associated with cervical lymph node biopsy, it affects 3-6% of patients and serves as a major cause of avoidable medical malpractice litigation. Medical malpractice cases not only affect the primary surgeon but also may include the repairing surgeon through a shift of blame. For this reason, we discuss the strategies all clinicians may utilize in approaching iatrogenic SAN injuries. By taking basic precautionary measures based on simple application of anatomy in the management of these patients, clinicians may protect themselves from needless malpractice litigation. A thorough knowledge of the anatomy and application in preventative strategies may provide guidance for clinicians in reducing the incidence of iatrogenic injuries, providing effective postinjury management, and ensuring the salvaging surgeon is not at fault if litigation is pursued.