American Society for Peripheral Nerve

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Treatment of Thoracic Outlet Compression Syndrome by Decompression of Brachial Plexus and Vessels between Cervical Foramen and Pectoralis Minor: Follow Up Study of 30 Cases
Shusen Cui, MD
Department of Hand Surgery, China-Japan Union Hospital, Jilin University, Jilin, China

Objective: We report our experience in the surgical treatment of thoracic outlet compression syndrome with decompression of brachial plexus and vessels between cervical foramen and pectoralis minor without first rib excision. This study evaluated the effectiveness of this new operative procedure in the treatment of patients with neurogenic thoracic outlet syndrome (NTOS).

Methods: In this procedure, the scalene area, cervical foramen and nerve roots, costoclavicular area and pectoralis minor area were all explored and released including remove of elongated C7 transverse process or cervical rib. Fifty patients who were diagnosed as NTOS were performed this new surgical procedure between August 2008 and July 2012. Before surgery, all clinical details of patients were recorded and all patients were asked to complete the SF-12, Brief Pain Inventory (BPI), Disabilities of the Arm, Shoulder and Hand (QuickDASH), Cervical Brachial Symptom Questionaire (CBSQ) and Visual Analogue Scale(VAS) survey. Also the NTOS Index introduced by Robert W. Thompson was calculated. All patients were followed up in July 2013 and were assessed again with above methods. The average scores of each indicator before and after the operation were analyzed.

Results: Only 30 patients of the 50 returned to the clinic and completed the re-evaluation with a mean follow up of 28.8 months (range 14-44 months). The mean age was 40 years (range 14-66 years) and 22 of them were female. Twenty nine patients of the 30 reported improvement of their symptoms and 28 patients reported good to excellent relief without recurrence. One patient had suture infection, 5 patients presented hypesthesia around the incision and 13 patients had mild pain of shoulder girdles. No patient needed additional surgical intervention. There were significant differences (P < .01) between preoperative and postoperative scores with respect to all of the evaluation indicators. The statistically results are as follows: (SF-12 : 34.73 vs 42.68 ; P< .01); (BPI : 38.68 vs 50.59; P< .01); (DASH : 55.07 vs 23.0 ; P< .01); (CBSQ: 69.10 vs 30.60 ; P< .01); (VAS:5.4 vs 2.6 ; P< .01); (NTOS Index : 55.44 vs 24.87 ; P< .01).

Conclusions: This new surgical approach for NTOS aims to explore the entire brachial plexus and vessels and remove all compression elements from cervical foramen to pectoralis minor, but not the first rib only when it is abnormal. It is an effective, low-risk and easy procedure for NTOS.

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