EMBARGOED RELEASE, JUNE 17, 2011, 11:08 AM
May 16, 2011
Transaxillary first rib resection and scalenectomy more successful in patient younger than 40
CHICAGO— Researchers from Johns Hopkins Medical Institutions in Baltimore, Md., reported today that people ages 40 and under have better outcomes when undergoing transaxillary first rib resection and scalenectomy (FRRS) for neurogenic thoracic outlet syndrome (NTOS). Details of their findings were presented at the 65th Vascular Annual Meeting® of the Society for Vascular Surgery®.
Julie Ann Freischlag, MD, surgeon-in-chief at The Johns Hopkins Hospital and director of the section of surgical sciences at the Johns Hopkins University School of Medicine noted that surgical management of neurogenic thoracic outlet syndrome (NTOS) remains suspect due to the lack of predictors of success. “The goal of our study was to examine effects of patient demographics, etiology and duration of symptoms, as well as the selective use of lidocaine and botulinum toxin anterior scalene blocks on outcomes of patients undergoing FRRS for NTOS,” said Dr. Freischlag.
Between 2003-2009, patients with NTOS who had failed physical therapy and had FRRS were retrospectively reviewed from a prospectively maintained database. Patients were stratified to age groups under 40 years (96) and those 40 years or older (63). Bivariate and multivariate statistical models of analysis were used.
One hundred and fifty-nine FRRS’s were identified. Sixteen cases were bilateral, 3 patients with cervical ribs, 84.3 percent were female and the median age 37 years (range 21-64). After a median follow-up of 12 months, FRRS was found more likely to relieve symptoms in patients under 40 vs. those 40 years and older (90 percent vs. 77.8 percent).
Patients who experienced trauma were 43 percent for the younger group in contrast to 46 percent in the older group. Also, patients who had problems with chronic repetitive motion included 57 percent in the younger group and 54 percent in the older group.
The younger group also had symptoms of 38.4 months in comparison to 66 months. More patients in the 40 and older group had more spine, shoulder or arm operations (38 percent vs. 18 percent). Lidocaine blocks were positive in 89 percent (50/56) patients in those younger than 40 years vs. 93 percent (40/43 patients) in the 40 and older group.
After adjusting for patient presenting factors in multivariate analysis, patients 40 years and older were more likely to have a successful outcome if they had a successful lidocaine nerve block prior to FRRS. Botulinum toxin blocks were successful in less patients, 40 percent (8/20 patients) in the younger group and 52.4 percent (11/21) in the older group, but were not predictive of symptom relief following FRRS.
“Patients with NTOS who are less than 40 years of age achieve more symptom relief following FRRS as compared to older patients,” said Dr. Freischlag. “Therefore patients and surgeons should be aware of less success with age when undergoing FRRS. In patients 40 years and younger, the selective use of lidocaine blocks is most beneficial.”
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