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Neurogenic thoracic outlet decompression: rationale for sparing the first rib

S W Cheng1, L M Reilly, N A Nelken

  • 1Department of Surgery, Division of Vascular Surgery, University of California, San Francisco, CA 94143, USA.

Cardiovascular Surgery (London, England)
|December 1, 1995
PubMed
Summary

Comparing surgical approaches for neurogenic thoracic outlet syndrome, this study found that rib-sparing decompression offers similar long-term success to rib resection but with less morbidity. Thorough scalene muscle removal is key for optimal outcomes.

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Area of Science:

  • Neurosurgery
  • Thoracic Surgery
  • Orthopedic Surgery

Background:

  • Neurogenic thoracic outlet syndrome (nTOS) is a condition caused by compression of the brachial plexus.
  • Surgical decompression is a common treatment for nTOS.
  • The supraclavicular approach is frequently used for nTOS decompression.

Purpose of the Study:

  • To compare the outcomes of rib resection versus rib-sparing supraclavicular decompression for nTOS.
  • To evaluate the impact of surgical technique on patient morbidity and long-term success.

Main Methods:

  • A retrospective review of 168 primary supraclavicular decompressions in 146 nTOS patients (excluding those with cervical ribs).
  • Comparison between 125 rib resection procedures and 43 rib-sparing procedures performed between 1983 and 1992.

Related Experiment Videos

  • Analysis of early and long-term success rates, complication rates, and return to employment.

    • Main Results:

    • Rib resection was associated with a higher rate of pleural injury (59% vs. 40%) and a longer hospital stay (p = 0.005).
    • Early success rates were comparable (83% rib resection vs. 91% rib sparing), as were long-term results (69% vs. 76% at 2 years).
    • Symptom duration prior to surgery was the most significant factor influencing clinical outcome.

    Conclusions:

    • Rib-sparing supraclavicular decompression for nTOS leads to less patient morbidity and shorter hospitalization compared to rib resection.
    • Thorough removal of scalene musculature and myofascial anomalies via the supraclavicular approach is recommended for nTOS.
    • The duration of symptoms is a critical determinant of surgical success in nTOS.