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Sonographically guided botulinum toxin injections in patients with neurogenic thoracic outlet syndrome: correlation with surgical outcomes

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Abstract

Objective

We examined the role of botulinum toxin (BTX) injections of anterior scalene (AS) and pectoralis minor (PM) muscles in patients undergoing surgery for neurogenic thoracic outlet syndrome (NTOS). We hypothesized that symptomatic improvement from BTX injections correlates with favorable long-term response to surgery for NTOS.

Materials and methods

This Health Insurance Portability and Accountability Act compliant study was approved by the institutional review board and prior informed consent requirement was waived. We retrospectively analyzed prospectively acquired data in NTOS patients who underwent sonographically guided chemodenervation of AS and PM using BTX type A followed by scalenectomy and first rib resection. Overall responses to BTX injections and surgery were recorded after each procedure. Statistical analyses were performed to determine correlation between responses to BTX injections and surgery.

Results

In 157 patients, 178 BTX injections followed by surgery were identified (114 females; mean age 38 ± 13 years). Responders and non-responders to BTX injections and surgery had similar preoperative symptom duration and age (P > 0.14). Better response to BTX injections correlated positively with better response to surgery (P = 0.003), persisting after adjustment for age, gender, and symptom duration (P = 0.03). A high proportion of responders to BTX injections also responded to surgery (positive predictive value of 99%), and BTX injections showed high specificity (90%). BTX injections were moderately sensitive (66%) and accurate (67%) to determine surgical response and had low negative predictive value (14%).

Conclusion

Response to BTX injections correlates positively with long-term surgical outcome in subjects with NTOS, potentially playing an important role in patient management.

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Author information

Author notes

  1. Dean M. Donahue and Ivan R. B. Godoy contributed equally to this work.

Authors and Affiliations

  1. Division of Thoracic Surgery, Department of Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, MA, 02114, USA

    Dean M. Donahue & Julie A. Donahue

  2. Division of Musculoskeletal Imaging and Intervention, Massachusetts General Hospital and Harvard Medical School, Boston, MA, 02114, USA

    Ivan R. B. Godoy & Martin Torriani

  3. Division of Neuroradiology, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, 02114, USA

    Rajiv Gupta

Authors
  1. Dean M. Donahue
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  2. Ivan R. B. Godoy
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  3. Rajiv Gupta
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  4. Julie A. Donahue
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  5. Martin Torriani
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Corresponding author

Correspondence to Martin Torriani.

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The authors declare that they have no conflicts of interest.

Ethical approval

All procedures performed in studies involving human participants were carried out in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.

Informed consent

Informed consent was waived for individual participants included in the study. The study was approved by the local Institutional Review Board (IRB) and HIPAA compliant.

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Donahue, D.M., Godoy, I.R.B., Gupta, R. et al. Sonographically guided botulinum toxin injections in patients with neurogenic thoracic outlet syndrome: correlation with surgical outcomes. Skeletal Radiol 49, 715–722 (2020). https://doi.org/10.1007/s00256-019-03331-9

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  • DOI: https://doi.org/10.1007/s00256-019-03331-9

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