Abstract
Objectives: The treatment for neurogenic thoracic outlet syndrome (NTOS) conventionally involves first-rib resection (FRR) surgery, which is quite challenging to perform, especially for novices, and is often associated with postoperative complications. Herein, we report a new segmental resection approach through piezo surgery that involves using a bone cutter, which can uniquely provide a soft tissue protective effect.Methods: This retrospective study involved the examination of 26 NTOS patients who underwent piezo surgery and another group of 30 patients who underwent FRR using the conventional technique. In the patient group that underwent piezo surgery, the rib was first resected into two pieces using a piezoelectric device and subsequently removed. In the patient group that underwent conventional surgery, the first rib was removed as one piece using a rib cutter and rongeurs.Results: The piezo surgery group had significantly shorter operative time (96.85 ± 14.66 vs. 143.33 ± 25.64 min, P < 0.001) and FRR duration (8.73 ± 2.11 vs. 22.23 ± 6.27 min, P < 0.001) than the conventional group. The posterior stump length of the residual rib was shorter in the piezo surgery group than in the conventional group (0.54 ± 0.19 vs. 0.65 ± 0.15 cm, P < 0.05). There were no significant differences in postoperative complications and scores of the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire, the Cervical Brachial Symptom Questionnaire (CBSQ), and the visual analog scale (VAS). Even the TOS index (NTOS Index = [DASH + (0.83 × CBSQ) + (10 × VAS)]/3) and patient self-assessments of both the groups showed no significant differences. Univariate analyses indicated that the type of treatment affected operative time.Conclusion: Our results suggest that piezo surgery is safe, effective, and simple for segmental FRR in NTOS patients. Piezo surgery provides a more thorough FRR without damaging adjacent soft tissues in a relatively short duration and achieves similar functional recovery as conventional techniques. Therefore, piezo surgery can be a promising alternative for FRR during the surgical treatment of NTOS.
Highlights
Neurogenic thoracic outlet syndrome (NTOS) is a compressive neuropathy caused by brachial plexus compression in the thoracic outlet region [1,2,3]
Among the initial cohort of 385 patients meeting the diagnostic criteria for NTOS, 96 (25%) obtained satisfactory symptom improvement with the initial physical therapy (PT) trial and chose to continue conservative management
Two patients from the conventional group and one from the piezo surgery group missed follow-up assessments; they were excluded from the analysis
Summary
Neurogenic thoracic outlet syndrome (NTOS) is a compressive neuropathy caused by brachial plexus compression in the thoracic outlet region [1,2,3]. Current instruments used for FRR include the Schumacher bone cutter, the Raney Rongeur, and Kerrison and duckbill rongeurs These are operated manually and require a large working space; this affects the operational field and increases the risk of soft tissue injury, making the conventional FRR technique more challenging, especially for novices [3, 22, 23]. To overcome these issues, we developed a sectional removal technique using an ultrasonic bone cutter, i.e., piezo surgery. Piezo surgery is simple and straightforward even for novices [26, 32]
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