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Updated: Jan 8, 2026
Transaxillary First Rib Resection for Treatment of the Thoracic Outlet Syndrome
Published on: September 13, 2020
Outcomes Following Surgical Management of Neurogenic Thoracic Outlet Syndrome: TriNetX Analysis Comparing Rib-Sparing
Ramin Shekouhi1, Hassan Darabi2, Yash Singh3
1Division of Plastic and Reconstructive Surgery, Department of Surgery, Louisiana State University Health Sciences Center, New Orleans, LA.
Background:
Neurogenic thoracic outlet syndrome (nTOS) results from compression of the brachial plexus and can lead to debilitating symptoms such as pain, paresthesia, and motor weakness. This study aimed to compare outcomes between patients undergoing rib-sparing scalenectomy (RSS) and those receiving first rib resection (FRR).
Methods:
The TrinetX Collaborative Network was queried for patients who underwent surgical treatment of nTOS. Adult patients with a diagnosis of nTOS who underwent either RSS or FRR between 2013 and 2025 were included. Patients were identified using Current Procedural Terminology codes and matched 1:1 via propensity score matching based on age, sex, and comorbidities. One-year outcomes including postoperative hand pain, hematoma, and reintervention rates were compared using risk differences, odds ratios, and Kaplan-Meier analysis.
Results:
There were a total of 5359 patients meeting the inclusion criteria, with 4352 (81.2%) patients in the FRR cohort and 1007 (18.8%) patients in the RSS cohort. After matching, 973 patients were included in each group. The incidence rates of postoperative pain (3.7% FRR vs 3.2% RSS) and hematoma (1.85% vs 2.05%) were similar between groups ( P > 0.05). Reintervention rates were also comparable for both FRR (7.8%) and RSS (7.6%). Kaplan-Meier analysis showed no significant difference in 1-year reintervention-free survival (FRR: 89.4% vs RSS: 89.5%, P > 0.05).
Conclusion:
In this large, matched cohort, rib-sparing scalenectomy and first rib resection yielded comparable 1-year outcomes for nTOS. Given the similar complication and reintervention rates, RSS may serve as an effective, less invasive alternative to FRR in select patients.
