Rib-Sparing Scalenectomy versus First Rib Resection for the Treatment of Neurogenic Thoracic Outlet Syndrome: Comparison of Patient-Reported Outcomes.

Abstract

Background: Neurogenic thoracic outlet syndrome (nTOS) is caused by compression of the brachial plexus (BP). Surgical intervention is pursued when conservative treatments fail. The present study aimed to investigate the mid-term functional outcomes of patients with nTOS who underwent first rib resection (FRR) compared to rib-sparing scalenectomy (RSS) using standardised patient-reported outcome measures (PROMs). Methods: The PROMs used included the Visual Analogue Scale (VAS), Patient Satisfaction Scale (PSS), Disabilities of the Arm, Shoulder and Hand (DASH) score, Michigan Hand Outcomes Questionnaire (MHQ) and Cervical Brachial Symptom Questionnaire (CBSQ). Statistical analyses compared outcomes between the RSS and FRR groups, with regression models accounting for confounding factors. Results: This study included 20 patients with supraclavicular nTOS, with a mean age of 42.5 ± 13.1 years and a mean BMI of 28.1 ± 5.5. There were 11 females (55.0%) and 9 males (45.0%). Mean postoperative follow-up before PROMs was 29.3 ± 13.9 months. The overall mean DASH, CBSQ and MHQ scores were 50.1 ± 34.1, 45.0 ± 42.1 and 59.8 ± 23.6, respectively. A significant positive correlation was observed between the Derkash score and time from symptom onset to surgery. Comparing FRR (n = 10) and RSS (n = 10), the DASH score was significantly higher in the FRR group (66.8 ± 36.2) compared to the RSS group (33.4 ± 22.9). No other significant differences in PROMs were found between the FRR and RSS groups. Conclusion: RSS and FRR were both effective in improving symptoms in nTOS, with RSS having a significantly lower DASH score postoperatively. Level of Evidence: Level III (Therapeutic).