Thoracic outlet syndrome; anterior approach

ABSTRACT

Thoracic outlet syndrome comprises a wide spectrum of disorders with different compressive pathologies attributed to the neurovascular bundle passing from the root of the neck to supply the upper extremity. New concepts and advances in diagnosis and treatment are emerging. This study evaluates effectiveness and safety of the anterior supraclavicular approach in management of neurovascular compression at the thoracic outlet. Ten patients [7 females and 3 males] with age average 29 years [range from 21 to 37 years] underwent anterior neurovascular decompression procedures because of symptoms of lower plexus compression [C8-T1]. Preoperative plain radiography, MRI and nerve conduction velocity studies confirmed the clinical diagnosis. Nine patients had neck pain, all had sensory deficit and eight had motor deficit. After 12 months of follow-up, 7 patients showed excellent results, 2 cases had good results and one case had fair results according to the visual analogue scale, and nerve conduction velocities. The past 50 years have seen improved recognition and management of TOS, which is still a challenging problem. We recommend nerve conduction velocity studies beside clinical assessment for diagnosis and follow up, and anterior supraclavicular approach in neurogenic decompression which is relatively safe and effective