Surgical Approaches and Prediction of Symptom Improvement for Neurogenic Thoracic Outlet Syndrome

Neurogenic thoracic outlet syndrome (nTOS) can be surgically treated via transaxillary (TA) or supraclavicular (SC) thoracic outlet decompression (TOD). Studies comparing patient-reported outcomes (PROs) between approaches are limited. The aim of this study was to assess differences in clinical outcomes and PROs after TA and SC TOD and to identify predictors of symptom improvement.

Patients who underwent TOD for nTOS between 2016 and 2024 were retrospectively identified. Demographics, preoperative testing, surgical approach, operative details, complications, and symptom resolution were collected. PROs were assessed using the Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire, Brief Pain Inventory (BPI), and pain catastrophizing scale (PCS) preand postoperatively. Differences between treatment groups and outcomes were assessed and cut-points predictive of symptom improvement were calculated.

A total of 147 TOD for nTOS [92 (62.6%) SC and 55 (37.4%) TA] were included. Although TA was associated with shorter operating room time and length of stay there were no differences in demographics, complications, postoperative symptoms, or improvements in PROs. Twenty-one (14.3%) patients reported no subjective symptom improvement. Higher preoperative PRO scores were associated with a lack of subjective symptom. Patients with a PCS ≥30 were less likely to experience symptom relief. A preoperative DASH >50.5 and BPI >73.5 were identified as predictors no symptom improvement.

There were no differences in clinical outcomes or PROs between TA and SC. Patients with a preoperative DASH score above 50.5, BPI of above 73.5, and/or PCS ≥30 may be less likely to experience symptom relief.