Scalenotomy for neurogenic thoracic outlet syndrome
Mohamed Hasan, Mustafa Alwalily, Mostafa Elsayed, Mohamed Elgebale, Abdelbaset Saleh, Adel Ragab, Hamdy Behary, Bokhary Mahmoud, and Hatem Elkhouly
Neurosurgery. Faculty of Medicine, Al- Azhar University, Egypt.
Abstract: Thoracic outlet syndrome (TOS) must be strongly evaluated in every case of upper limb complain as TOS is often the underlying cause of refractory upper limb conditions facing neurosurgeon or orthopedic surgeon like frozen shoulder, cervical disc (as a double or a multiple crush syndromes) or carpal tunnel syndrome that frequently defy standard treatment protocols and surgeon must select the safest surgical approach for surgically indicated cases. The aim of this study is to evaluate supraclavicular scalenotomy for true neurogenic thoracic outlet syndrome. Patients and Methods: twenty patients with neurogenic thoracic outlet syndrome were operated on between 2008 and 2011. Mean age was 38.05±8.85 years (range, 17 to 58 years); female/male ratio was 17/3. The most frequent symptom was paresthesia (75.0%). Seven patients (35%) had bilateral symptoms. All cases (20 cases) were true neurogenic thoracic outlet syndrome (excluding disputed cases). Lower plexus (C8-T1/ulnar nerve) compression was present in 18 patients and upper plexus (C5-C7/median nerve) compression in 2 patients. Preoperative evaluation was done for all patients and includes plain radiography, nerve conduction velocity and MRI cervical, and MRI angiography for selected cases (not all). The indication for surgery was failure of conservative treatment for 6 months. The decision to operate was made if symptoms persisted after conservative therapy in a patient with true neurogenic thoracic outlet syndrome. Cervical rib cases, radiographic occurrence of cervical rib alone is not an indication for surgery unless associated with symptoms. Results: there were clinical and electrophysiologic improvement of the preoperative complaint in all cases (Mean ulnar nerve conduction velocity was 58.0±6.07 m/s, range, 43 to 68 m/s) preoperatively and 66.55±5.63 m/s (range, 47 to 70 m/s) postoperatively (p < 0.05) ) without any recorded complications nor recurrence during 1 year follow up period. Conclusion: Surgical decompression for thoracic outlet syndrome by only scalenotomy and release of associated bands(without interruption of osseous elements) is efficient and safe for true neurogenic thoracic outlet syndrome.
[Mohamed Hasan, Mustafa Alwalily, Mostafa Elsayed, Mohamed Elgebale, Abdelbaset Saleh, Adel Ragab, Hamdy Behary, Bokhary Mahmoud, and Hatem Elkhouly. Scalenotomy for neurogenic thoracic outlet syndrome. J Am Sci 2013;9(3): 168-172] (ISSN: 1545-1003). http://www.jofamericanscience.org 21
Keyword: thoracic outlet syndrome, anterior decompression,TOS diagnostic scale. Full Text 21