Scalenot
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
