Novel Use of Ali Shahab Score as a Diagnostic Tool and Decision of Surgical Management in Scalenus Syndrome: A Case Series

Ali Shahab; Tjokorda G. B. Mahadewa; Wismaji Sadewo; Putu Eka Mardhika; Steven Awyono; Made Bhuwana Putra; Maria Monica

doi:10.3889/oamjms.2022.8510

Authors

Ali Shahab Department of Neurosurgery, Gatot Soebroto Army Hospital and Siloam Asri Hospital, Jakarta Indonesia
Tjokorda G. B. Mahadewa Department of Surgery, Neurosurgery Division, Faculty of Medicine, Udayana University, Sanglah Hospital, Bali, Indonesia https://orcid.org/0000-0002-4445-4085
Wismaji Sadewo Department of Neurosurgery, Faculty of Medicine, Indonesia University, Dr Cipto Mangunkusumo Hospital, Jakarta, Indonesia https://orcid.org/0000-0002-1953-7997
Putu Eka Mardhika Department of Surgery, Neurosurgery Division, Faculty of Medicine, Udayana University, Sanglah Hospital, Bali, Indonesia https://orcid.org/0000-0002-2260-9437
Steven Awyono Department of Surgery, Neurosurgery Division, Faculty of Medicine, Udayana University, Sanglah Hospital, Bali, Indonesia https://orcid.org/0000-0001-6394-0030
Made Bhuwana Putra Department of Surgery, Neurosurgery Division, Faculty of Medicine, Udayana University, Sanglah Hospital, Bali, Indonesia https://orcid.org/0000-0001-8472-2163
Maria Monica Department of Surgery, Neurosurgery Division, Faculty of Medicine, Udayana University, Sanglah Hospital, Bali, Indonesia

DOI:

https://doi.org/10.3889/oamjms.2022.8510

Keywords:

Scalenectomy, Scalenus syndrome, Scalenus triangle, Sympathetic hypertonia, Case series

Abstract

BACKGROUND: Scalenus syndrome is a collection of symptoms as the consequences of nerve and vascular compression within the scalene triangle. However, the entity has long been forgotten in publications and is difficult to recognize. The diagnosis of scalenus syndrome is mainly based on clinical findings. The Ali Shahab score is a new scoring system, generated based on clinical symptoms of scalenus syndrome.

AIM: In this study, we presented a case series of scalenus syndrome patients who were diagnosed and decide to be managed surgically based on Ali Shahab score. We also reported post-operative outcomes following scalenectomy in our series.

METHODS: This was a case series including patients with scalenus syndrome in Gatot Soebroto Army Hospital, Indonesia, and Siloam Asri Hospital, Indonesia, between 2016 and 2021. The diagnosis of scalenus syndrome was made based on Ali Shahab score with a value of more than 7. All patients were performed scalenectomy to decompress the stenotic subclavian artery and brachial plexus from surrounding fibrotic tissue. Eligible subjects were assessed for sex, side of symptoms, pre-operative and post-operative Ali Shahab score, and post-operative outcome.

RESULTS: We included 96 patients with scalenus syndrome in this case series. Most of the included patients were male (59.4%) and experienced scalenus syndrome on the right side (76%). The average pre-operative Ali Shahab score in our series was 7.12 ± 0.48 and the post-operative score was 0.11 ± 0. Regarding post-operative outcomes, more than half of the patients experienced symptoms reduction with 38.5% of patients experiencing complete resolution of symptoms following scalenectomy.

CONCLUSION: The application of the Ali Shahab score may be used as a diagnostic tool and decision of surgical management for scalenus syndrome patients. Decompression of the subclavian artery and releasing brachial plexus from surrounding fibrotic tissue can improve clinical symptoms in scalenus syndrome patients.

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