Long-term outcome of surgery for thoracic outlet syndrome

Abstract

Thoracic outlet syndrome (TOS) is one of the most controversial symptom complexes in surgery today. Even the existence of TOS is questioned and where it seems to exist, the incidence varies from one country to another. Surgery is often considered the primary treatment; however, the frequency of good results after surgery varies from 24% to 100%, and in recent years the surgical approach has been questioned. In this study 45 patients who had undergone surgery for TOS symptoms over a period of 21 years were examined by an independent clinician an average of 8 years after the operation. Forty-three percent of the performed operations were found to have been successful. Preoperative nocturnal and neck pain were more frequent in the unsuccessful group; no other preoperative characteristics had a predictive value. Preoperative radiographic and neurophysiologic examinations were also not predictive of the outcome. It is recommended that the feasibility of conservative therapeutic approaches should be evaluated before undertaking surgery for TOS symptoms.