Measurement of Outlet Pressures Favors Rib Resection for Decompression of Thoracic Outlet Syndrome

Area of Science:

• Neurosurgery
• Thoracic Surgery
• Orthopedic Surgery

Background:

• Conservative treatment for thoracic outlet syndrome (TOS) often fails.
• Scalenectomy with or without first-rib resection (FRR) is the primary surgical intervention for TOS.
• The necessity of FRR for complete costoclavicular space decompression remains debated.

Purpose of the Study:

• To evaluate the impact of first-rib resection (FRR) on costoclavicular space pressure in neurogenic thoracic outlet syndrome (nTOS).
• To determine if FRR is essential for complete decompression of the costoclavicular space in nTOS patients.

Main Methods:

• A retrospective study involving 15 patients (16 cases) with nTOS undergoing supraclavicular anterior-middle scalenectomy with FRR.
• Costoclavicular space pressures were measured using a balloon catheter with the arm in neutral and abducted/externally rotated positions, before and after scalenectomy, and after FRR.
• Paired Student's t-test analyzed pressure differences; patient outcomes were assessed using the Derkash classification and quick disabilities of the arm, shoulder, and hand (qDASH) questionnaire.

Main Results:

• No significant pressure change difference was observed between arm positions before or after scalenectomy alone.
• A significant reduction in pressure change between arm positions was noted only after FRR (mean change: 50.56 ± 40.28 mm Hg).
• Postoperative qDASH scores averaged 20 ± 23.2, with all patients reporting symptom and functional improvement.

Conclusions:

• Supraclavicular FRR for nTOS is safe and yields favorable outcomes.
• FRR significantly mitigates pressure increases in the costoclavicular space during arm abduction and external rotation.
• These findings suggest that scalenectomy alone may lead to incomplete decompression in nTOS management.