Ottestad Einar, Wilson Thomas J
1Department of Anesthesiology, Perioperative and Pain Medicine, and.
2Department of Neurosurgery, Stanford University, Stanford, California.
J Neurosurg. 2022 Sep 9;138(5):1411-1418. doi: 10.3171/2022.7.JNS221223. Print 2023 May 1.
Periscapular pain has a broad differential diagnosis. Dorsal scapular neuropathy is part of that differential diagnosis but is often forgotten by clinicians, leading to delayed diagnosis, chronic pain, and potentially worse outcomes. The objective of this study was to describe our method for diagnosis, surgical technique, intraoperative findings, and outcomes in consecutive patients undergoing dorsal scapular nerve (DSN) decompression.
A retrospective cohort study was performed to compile and describe outcomes for consecutive patients (n = 21) who underwent DSN decompression by a single surgeon during the period between August 2018 and February 2021. The primary outcome was change in visual analog scale (VAS) score for periscapular pain between baseline and 6 months postoperatively. Secondary outcomes included change in VAS score for overall pain, change in Disabilities of the Arm, Shoulder, and Hand (DASH) score, and change in the Zung Self-Rating Depression Scale (Zung SDS) between baseline and 6 and 12 months postoperatively.
Patients undergoing DSN decompression showed significant improvement in VAS score for periscapular pain between baseline and 6 months postoperatively (mean score 54.0 vs 26.8, respectively; p < 0.001). Fifteen of 21 patients (71%) had a good outcome (score improvement ≥ 20). Disability (as determined by DASH scores) was significantly improved at 6 and 12 months postoperatively. The only factor that was predictive of outcome was symptom duration, with longer symptom duration predicting a poor outcome.
Surgical treatment of dorsal scapular neuropathy is associated with significant improvements in pain and disability, and these improvements are durable. Morbidity associated with surgical treatment is low.
肩胛周围疼痛的鉴别诊断范围广泛。肩胛背神经病变是鉴别诊断的一部分，但临床医生常常将其遗漏，导致诊断延误、慢性疼痛，并可能产生更差的预后。本研究的目的是描述我们对连续接受肩胛背神经（DSN）减压手术的患者进行诊断、手术技术、术中发现及预后的方法。
进行一项回顾性队列研究，以汇总并描述2018年8月至2021年2月期间由单一外科医生为连续患者（n = 21）实施DSN减压手术的预后情况。主要结局指标是术前基线与术后6个月之间肩胛周围疼痛视觉模拟量表（VAS）评分的变化。次要结局指标包括术前基线与术后6个月及12个月之间总体疼痛VAS评分的变化、上肢、肩部和手部功能障碍（DASH）评分的变化以及zung自评抑郁量表（zung SDS）的变化。
接受DSN减压手术的患者在术前基线与术后6个月之间肩胛周围疼痛的VAS评分有显著改善（平均评分分别为54.0和26.8；p < 0.001）。21例患者中有15例（71%）预后良好（评分改善≥20）。术后6个月和12个月时，残疾情况（由DASH评分确定）有显著改善。唯一可预测预后的因素是症状持续时间，症状持续时间越长，预后越差。
肩胛背神经病变的手术治疗可显著改善疼痛和残疾状况，且这些改善是持久的。手术治疗相关的发病率较低。
