Measurement of Outlet Pressures Favors Rib Resection for Decompression of Thoracic Outlet Syndrome.
- 2020
BACKGROUND: When conservative therapy for thoracic outlet syndrome (TOS) fails, scalenectomy with or without first-rib resection(FRR) is the treatment of choice. We measured pressure in the costoclavicular space(CCS) before and after FRR at time of neurogenic TOS(NTOS) release to evaluate if FRR is required to completely decompress the CCS. CONCLUSIONS: First rib resection for management of NTOS can be safely performed with favorable outcomes. The pressure increase experienced in the CCS caused by arm abduction and external rotation was significantly reduced only post-FRR, raising concerns about potential incomplete CCS decompression with scalenectomy alone for NTOS management. Copyright (c) 2020. Published by Elsevier Inc. METHODS: Using a supraclavicular exposure for anterior-middle scalenectomy with FRR, CCS pressures were measured using a balloon catheter with patient's arm in neutral anatomic position-the arm abducted and externally rotated. Pressures were recorded in both arm positions pre-scalenectomy, post-scalenectomy, and post-FRR. Paired t-test was used to compare differences in group means for paired samples. Patient-reported outcomes were reported using the Derkash classification and Quick Disabilities of the Arm, Shoulder, and Hand (qDASH) questionnaire. RESULTS: Fifteen patients(16 cases) surgically treated for NTOS were included in this retrospective study. There was no significant difference in pressure change between arm positions pre-scalenectomy(161.56 +/- 71.65 mmHg difference) or post-scalenectomy(148.5 +/- 80.24 mmHg difference). There was a significant difference in pressure change between arm positions when comparing post-scalenectomy and post-FRR; mean pressure change between arm positions post-FRR was 50.56 +/- 40.28 mmHg. Mean post-operative qDASH score was 20 +/- 23.2. All patients reported improvement in symptoms and functional status.