Thoracic outlet compression neuropathy and decompression surgery at chang gung memorial hospital

Abstract

Introduction

Thoracic outlet syndrome (TOS) has many controversies that include nomenclature, etiology, diagnosis, treatment and surgical approach. The aim of this article is to give a comprehensive review of our experience of treatment of TOS for more than 35 years.

Materials and methods

From 1985 to 2021, a total of 100 TOS patients were treated and 114 surgeries were performed. They all had decompression surgeries for their compression neuropathy in the thoracic outlet with at least one year postoperative follow-up. Fourteen patients were bilateral TOS, undergoing bilateral TOS surgeries. Preoperative evaluation covered “TOS Examination Sheet” and imaging studies MRI and CT. Diagnosis was confirmed by intraoperative findings. All had near-total resection of the anterior scalene muscle and the first rib. Additional structual abnormalities were treated at the same time. The operative time was typically 2–3 h.

Results

Major postoperative complications were rare. Nearly all patients (96%) experienced significant symptoms and signs relief after a period of clinical follow-up and rehabilitation.

Conclusion

TOS is a real clinical entity. Once the preoperative diagnosis is made, conservative treatment is followed but failed, decompression surgery with extensive resection of anterior scalene muscle and the 1^st rib, and any other structural abnormalities is recommended to resolve the problems. Long-term postoperative follow-up is crucial and important to resolve the residual problems. Our result carries a 96% success rate with a favorable benefit:risk ratio.