Thoracic outlet syndrome associated with cervicothoracic scoliosis.

Background: Thoracic outlet syndrome (TOS) is a debilitating neurologic condition that is commonly encountered in routine neurosurgical practice. It causes severe pain, paresthesias, and weakness in the affected limb and can negatively impact patients' quality of life. Classically, TOS is caused by compression of the neurovascular bundle in the thoracic outlet region, often by soft tissue or bony anomalies. A relationship to cervicothoracic scoliosis has not been previously reported. The purpose of this case series is to report on the clinical and radiographic findings, surgical interventions, and clinical outcomes in patients with TOS and concurrent cervicothoracic scoliosis. We hypothesize that the abnormal cervicothoracic curvature may contribute to compression within the thoracic outlet.

Methods: Patients who presented to the senior author's clinic and had both cervicothoracic scoliosis and TOS were identified, and a retrospective chart review was performed. A review of the electronic medical records was used to collect clinical information and outcomes data. The study is a retrospective case series of patients who presented to the senior author's clinic and underwent surgical intervention by the senior author at a university hospital. Ten patients were identified as having symptoms consistent with TOS and were also found to have coexisting cervicothoracic scoliosis. We report on the preoperative physiology measures, such as imaging and electrodiagnostic findings, and postoperative self-reported symptoms and functional measures.

Results: Ten patients who presented to the clinic for evaluation of symptoms consistent with TOS were also noted to have mild-to-moderate cervicothoracic scoliosis. Eight of these patients underwent surgical intervention for their TOS, including anterior scalenectomy, pectoralis minor release, first rib resection, or a combination of the three procedures. Four patients underwent bilateral procedures. At 3 months, all patients (100%) had improvement in their numeric rating scale, and at 1 year, this dropped to 83%.

Conclusion: It is well-known that bony abnormalities, such as the presence of a cervical rib or elongated C7 transverse process, can lead to the development of TOS; however, a relationship to scoliosis, which similarly may deform the thoracic outlet region has not been reported. The relationship between these two conditions merits ongoing clinical evaluation.