Considerations for Surgical Treatment of Neurogenic Thoracic Outlet Syndrome: A Meta-Analysis of Patient-Reported Outcomes

Mario Blondin; Garrett L Garner; Keegan M Hones; David Spencer Nichols; Elizabeth A Cox; Harvey Chim

doi:10.1016/j.jhsa.2023.03.005

Considerations for Surgical Treatment of Neurogenic Thoracic Outlet Syndrome: A Meta-Analysis of Patient-Reported Outcomes

J Hand Surg Am. 2023 Jun;48(6):585-594. doi: 10.1016/j.jhsa.2023.03.005. Epub 2023 Apr 11.

Authors

Mario Blondin¹, Garrett L Garner², Keegan M Hones¹, David Spencer Nichols¹, Elizabeth A Cox¹, Harvey Chim³

Affiliations

¹ College of Medicine, University of Florida, Gainesville, FL.
² School of Medicine, Mercer University, Savannah, GA.
³ Division of Plastic & Reconstructive Surgery, Department of Surgery, University of Florida, Gainesville, FL. Electronic address: harveychim@yahoo.com.

PMID: 37055338
DOI: 10.1016/j.jhsa.2023.03.005

Abstract

Purpose: It remains unclear whether first rib resection (FRR), performed via a supraclavicular (SCFRR) or transaxillary (TAFRR) approach, is necessary for patients with neurogenic thoracic outlet syndrome (nTOS). In a systematic review and meta-analysis, we performed a direct comparison of patient-reported functional outcomes following different surgical approaches for nTOS.

Methods: The authors searched PubMed, Embase, Web of Science, Cochrane Library, PROSPERO, Google Scholar, and the gray literature. Data were extracted based on the procedure type. Well-validated patient-reported outcome measures were analyzed in separate time intervals. Random-effects meta-analysis and descriptive statistics were used where appropriate.

Results: Twenty-two articles were included, with 11 discussing SCFRR (812 patients), 6 discussing TAFRR (478 patients), and 5 discussing rib-sparing scalenectomy (RSS; 720 patients). The mean difference between preoperative and postoperative Disabilities of the Arm, Shoulder and Hand score was significantly different comparing RSS (43.0), TAFRR (26.8), and SCFRR (21.8). The mean difference between preoperative and postoperative visual analog scale scores was significantly higher for TAFRR (5.3) compared to SCFRR (3.0). Derkash scores were significantly worse for TAFRR compared to RSS or SCFRR. RSS had a success rate of 97.4% based on Derkash score, followed by SCFRR and TAFRR at 93.2% and 87.9%, respectively. RSS had a lower complication rate compared to SCFRR and TAFRR. There was a difference in complication rates: 8.7%, 14.5%, and 3.6% for SCFRR, TAFRR, and RSS, respectively.

Conclusions: Mean differences in Disabilities of the Arm, Shoulder and Hand scores and Derkash scores were significantly better for RSS. Higher complication rates were reported after FRR. Our findings suggest that RSS is an effective option for the treatment of nTOS.

Type of study/level of evidence: Therapeutic IV.

Keywords: Brachial plexus; rib resection; supraclavicular; thoracic outlet syndrome; transaxillary.

Publication types

Systematic Review
Meta-Analysis

MeSH terms

Decompression, Surgical* / methods
Humans
Retrospective Studies
Ribs / surgery
Thoracic Outlet Syndrome* / surgery
Treatment Outcome