Long-Term Functional Results for the Surgical Management of Neurogenic Thoracic Outlet Syndrome

• Published in: Vascular and endovascular surgery 2010-10, Vol.44 (7), p.550-555
• Main Authors: Scali, Salvatore, Stone, David, Bjerke, Aja, Chang, Catherine, Rzucidlo, Eva, Goodney, Phillip, Walsh, Daniel
• Format: Article
• Language: English
• Subjects: Activities of Daily Living; Adolescent; Adult; Biological and medical sciences; Decompression, Surgical; Disability Evaluation; Employment; Female; Humans; Male; Medical sciences; Middle Aged; Narcotics - therapeutic use; Nerve Block; Neurology; New Hampshire; Physical Therapy Modalities; Recovery of Function; Reoperation; Retrospective Studies; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Thoracic Outlet Syndrome - diagnosis; Thoracic Outlet Syndrome - physiopathology; Thoracic Outlet Syndrome - surgery; Time Factors; Treatment Outcome; Tumors of the nervous system. Phacomatoses; Vascular surgery: aorta, extremities, vena cava. Surgery of the lymphatic vessels; Young Adult
• ISSN: 1538-5744; 1938-9116
• DOI: 10.1177/1538574410374658

Objective: To document long-term functional outcomes in patients treated for neurogenic thoracic outlet syndrome (NTOS). Methods: Records of all patients undergoing treatment for NTOS at our center were reviewed. Patient demographics and co-morbidities were recorded. End-points included symptomatic relief, peri-operative adjunctive procedures, functional outcome and employment continuity. Results: From 1988-2008, 26 patients were operated upon for NTOS. Hallmarks of the diagnosis in operated patients included symptom duration less than 1 year and a positive Roos test. Patients receiving disability and those with cervical spine pathology or carpal tunnel syndrome were not considered for surgery. Mean patient age was 39.2 years (range 14-60 years) with a mean follow-up of 104.4 months. Eleven patients (42.3%) engaged in pre-operative physical therapy programs. 7 of 9 patients (26.9%) received adjunctive peri-procedural scalene block with temporary symptom relief. All patients underwent thoracic outlet decompression by either 1st rib resection [18 total: 8 (44%) transaxillary and 10 (66%) supraclavicular)], cervical rib resection [6 (26.1%)] and/or scalenectomy [12 (46.2%)]. Of the 22 patients available for follow-up, six patients (27.3%) have required continued post-operative narcotic analgesics. Sixteen patients (72.7%) returned to work and reported being at an equivalent or better functional outcome than their pre-operative status. Conclusions: Durable long-term functional outcomes can be achieved predicated on a highly selective approach to the surgical management of patients with NTOS. A majority of operated patients will not require adjunctive procedures or chronic narcotic utilization. Patients who undergo surgery can expect to return to work with little or no functional impairment.