Safety and Efficacy of Posterior Upper Rib Excision and Decompression Technique for Surgical Treatment of Neurogenic Thoracic Outlet Syndrome

BACKGROUND: There are several approaches used for surgical treatment of neurogenic thoracic outlet syndrome (n-TOS). The posterior upper rib excision and decompression technique is a novel technique that was developed and used by the author for the past 8 years. The purpose of this paper is to report clinical outcomes of patients treated with this approach. -METHODS: All patients with n-TOS operated by single surgeon from 2015 to 2023 were retrospectively analyzed. Demographic, clinical, radiologic, surgical, and post-operative data were collected and reported with emphasis on efficacy and complications. The surgical success was evaluated subjectively as excellent, good, fair, poor, and bad. Radiologic data were analyzed to assess the extent of accessory/first rib removal. -RESULTS: Eighty procedures were performed in 61 pa-tients with a mean follow-up of 1153 (87-3048) days. The majority (60.7%) of patients were women, with 39.3% being men. In 11 cases (18%) causative factor was bone abnor-mality. Two patients were previously operated at another centers (3.3%). Total mean subjective improvement rate was 91.5%. More than half (55) of the patients reported "excellent" (>75%) and 6 "good" improvements (50% L75%); no fair, poor, and worse outcomes were reported. Patients reporting "good" outcome had statistically sigificant shorter follow-ups than the "excellent" group (P < 0.001). Complications included pleural opening, Horner syndrome, and apical hematoma, none of which were permanent.CONCLUSIONS: The posterior upper rib excision and decompression approach provides excellent clinical out-comes in patients with n-TOS. It allows better intra-operative visualization and removal of the first rib and full decompression of the neurovascular bundle.