Ultrasound-Guided the Prevertebral Fascia Incise and the C5 Root Hydrodissection for the Treatment of Neurogenic Thoracic Outlet Syndrome: an Application Study.

Abstract

Objective: The aim of this retrospective study was to evaluate the effectiveness of ultrasound-guided hydrodissection of the C5 nerve root, in combination with prevertebral fascia incision, as a treatment for neurogenic thoracic outlet syndrome (NTOS).

Methods: Between January 2023 and January 2024, a total of 34 patients diagnosed with NTOS were enrolled in the treatment group, all of whom underwent ultrasound-guided hydrodissection of the C5 nerve root and prevertebral fascia incision. A control group consisting of 34 healthy participants was also included for comparative purposes. Preoperative and postoperative ultrasound measurements were taken at 1 and 6 weeks, including the thickness of the prevertebral fascia, the distance between the C5 nerve root and fascia, and the cross-sectional area (CSA) of the C5 nerve root. Pain intensity and functional status were assessed using the Visual Analog Scale (VAS) and Disabilities of the Arm, Shoulder, and Hand (DASH) scores.

Results: Preoperative measurements in the NTOS group showed increased prevertebral fascia thickness (median: 0.1 mm [IQR 0.08-0.12]), reduced distance between the C5 nerve root and the fascia (median: 0.13 mm [IQR 0.10-0.16]), and a larger CSA of the C5 nerve root (median: 0.08 mm² [IQR 0.06-0.10]). Post-treatment, VAS scores significantly improved from a median of 7 (IQR 6-8) to 2 (IQR 2-3) at 1 week and remained stable at 6 weeks, while DASH scores improved from 85 (IQR 82-89) to 34 (IQR 31-36) at 1 week and 33 at 6 weeks.

Conclusion: Ultrasound-guided hydrodissection of the C5 nerve root, along with prevertebral fascia incision, is an effective, minimally invasive treatment for NTOS.