Reoperation for recurrent thoracic outlet syndrome

Area of Science:

• Neurosurgery
• Thoracic Surgery
• Peripheral Nerve Surgery

Background:

• Recurrent thoracic outlet syndrome (TOS) after initial first rib resection is rare, affecting 1% of cases.
• Patients present with severe, unrelenting neurological symptoms including pain and paresthesia in the neck, shoulder, arm, and hand.
• Symptom recurrence typically manifests within months to years after the primary surgery.

Purpose of the Study:

• To evaluate the efficacy of reoperation for recurrent thoracic outlet syndrome.
• To identify optimal surgical approaches for managing recurrent TOS.
• To assess the impact of reoperation on neurological function.

Main Methods:

• A retrospective review of 30 patients undergoing reoperation for recurrent TOS.
• Assessment of neurological symptoms and nerve conduction velocities (NCVs) pre- and post-reoperation.
• Surgical intervention utilizing the high posterior thoracoplasty approach for neurolysis and decompression.

Main Results:

• Pre-reoperation NCVs averaged 51 m/s (normal 72 m/s), indicating significant nerve compromise.
• Reoperation, following conservative management, was required due to persistent, severe symptoms.
• Post-reoperation NCVs improved to an average of 66 m/s, with gratifying symptom relief.

Conclusions:

• The high posterior thoracoplasty approach provides superior exposure for safe neurolysis and complete removal of scar tissue and residual rib fragments during TOS reoperation.
• Reoperation for recurrent TOS can significantly improve nerve conduction and alleviate debilitating neurological symptoms.
• This approach is recommended for managing recurrent thoracic outlet syndrome to achieve favorable patient outcomes.