Outcomes Following Surgical Management of Neurogenic Thoracic Outlet Syndrome: TriNetX Analysis Comparing Rib-Sparing...

Area of Science:

• Neurosurgery
• Thoracic Surgery
• Vascular Surgery

Background:

• Neurogenic thoracic outlet syndrome (nTOS) involves brachial plexus compression, causing pain, paresthesia, and weakness.
• Surgical interventions aim to decompress the neurovascular structures.
• Comparing rib-sparing scalenectomy (RSS) and first rib resection (FRR) is crucial for optimizing nTOS treatment.

Purpose of the Study:

• To compare the 1-year postoperative outcomes of RSS versus FRR in patients with nTOS.
• To evaluate differences in pain, hematoma, and reintervention rates between the two surgical approaches.
• To determine if RSS is a viable, less invasive alternative to FRR.

Main Methods:

• A retrospective analysis of the TrinetX Collaborative Network database.
• Inclusion of adult patients diagnosed with nTOS undergoing RSS or FRR between 2013 and 2025.
• Propensity score matching (1:1) based on age, sex, and comorbidities for cohort comparison.
• Analysis of postoperative hand pain, hematoma, and reintervention rates using risk differences, odds ratios, and Kaplan-Meier survival analysis.

Main Results:

• A total of 5359 patients were initially identified; 973 were matched in each group (FRR vs. RSS).
• Postoperative pain incidence (3.7% vs. 3.2%) and hematoma rates (1.85% vs. 2.05%) were statistically similar between FRR and RSS groups (P > 0.05).
• Reintervention rates (7.8% vs. 7.6%) and 1-year reintervention-free survival (89.4% vs. 89.5%) were comparable between the FRR and RSS cohorts (P > 0.05).

Conclusions:

• Rib-sparing scalenectomy (RSS) and first rib resection (FRR) demonstrate comparable 1-year outcomes for neurogenic thoracic outlet syndrome (nTOS).
• The similar rates of complications and reinterventions suggest RSS is an effective alternative.
• RSS may be a suitable, less invasive surgical option for select nTOS patients compared to FRR.