Extensive supraclavicular rib resection and scalenectomy in neurogenic type of thoracic outlet compression syndrome

Abstract

Background The majority of patients with thoracic outlet compression syndrome present with vague upper limb pain and paresthesia and lack clear evidence of compression on investigations and are known as the 'disputed Neurogenic type'. Patients and methods We retrospectively reviewed 39 patients (eight bilateral) who underwent 47 operations to evaluate the prognosis, outcome, and complications of surgical treatment of the disputed neurogenic type of thoracic outlet syndrome by extensive anterior supraclavicular decompression with complete excision of the first rib, the cervical rib and/or an elongated transverse process of C7 as well as scalenectomy and excision of any anomalous fibromuscular bands. Results Results were graded on the basis of symptomatic improvement. Excellent results were reported in 24 (51%) operations, good results in 18 (38%), and fair results in five (11%) operations. None of our patients considered their operation as a failure. There were no major complications; however, recurrence of symptoms occurred in three (6.5%) patients after an average of 19 months. Conclusion This procedure was found to be successful, with a low rate of complications and recurrence.