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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
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.
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.
- 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.