Thoracic Outlet Syndrome Decompression in Adolescents
Heather L Minton, BS1; Erin F Ransom, MD1; Bradley L Young, MD2; Martim C Pinto, MD1; Brent A Ponce, MD1; Richard D Meyer, MD1; (1)University of Alabama at Birmingham, Birmingham, AL, (2)Carolinas Medical Center, Charlotte, NC
Title: Thoracic Outlet Syndrome Decompression in Adolescents
Introduction: Neurogenic Thoracic Outlet Syndrome (NTOS) is relatively uncommon in the general population and less common in adolescents. This study aims to characterize surgical outcomes following NTOS decompression in adolescents and identify relationships between perioperative factors and surgical outcomes.
Methods: A retrospective review was conducted of adolescent patients surgically treated for NTOS at a single institution from 2000 to 2015. Perioperative factors and functional outcomes were assessed using the quick Disabilities of Arm, Shoulder, and Hand (quick-DASH) survey, Cervical-Brachial Symptom Questionnaire (CBSQ), the 10-point visual analog scale (VAS) for pain, and the Single Assessment Numeric Evaluation (SANE). Study data were collected and managed using REDCap electronic data capture tools. Analysis of variance was conducted using Statistical Analysis Software and Microsoft Excel.
Results: Study population consisted of 63 adolescents aged 8-21 at time of presentation, with a median age of 15 years. The dominant arm was affected in 65% of patients. Mechanisms of injury primarily involved overuse (28; 47.5%) or trauma (13; 22.1%). Surgical intervention was selected in patients whom conservative management was unsuccessful. The surgical procedure was tailored to each patient and commonly involved neurolysis of the brachial plexus (98.4%), anterior scalenectomy (93.8%), middle scalenectomy (87.5%), and excision of anomalous soft tissue (40.6%). The average length of stay was 1.04 +/- 0.19 days. Repeat surgeries (2, 3.1%) were rare. Cervical ribs or other osseous anomalies were seen in 14.1% of patients, while soft tissue anomalies were seen in 73.4% of patients. Long term follow-up averaging 64.2 months identified an improvement in the VAS of 6.14 points from a preoperative average score of 8.0 and postoperative average score of 2.14. The average SANE score before surgery was 26.9 and after was 85.24. The average postoperative quickDASH and CBSQ scores were 12.23 with a range from 0 to 52.27 on a 100-point scale and 27.62 with a range from 0 to 92 on a 120-point scale, respectively.
Conclusion: Following failure of non-operative treatment, surgical decompression relieves symptoms and allows reliable return to recreational activities in adolescent patients with NTOS.
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