Surgery effective treatment option for Neurogenic thoracic outlet syndrome patients

In a new study by Jens Goeteyn and team it was shown that individuals who do not react to conservative therapy might benefit from transaxillary thoracic outlet decompression (TA-TOD) for Neurogenic thoracic outlet syndrome (NTOS). The findings of this study were published in the European Journal of Vascular and Endovascular Surgery.

One of the clinical entities in medicine that receives the most debate is neurogenic thoracic outlet syndrome. Several significant case studies have demonstrated positive surgical outcomes, however there is a paucity of reliable scientific data. Therefore, the objective of this study was to evaluate the impact of thoracic outlet decompression (TOD).

A parallel group design, non-blinded, randomized controlled study was carried out at a single center (high volume, tertiary TOS center). A transaxillary thoracic outlet decompression or prolonged conservative therapy were offered to patients with NTOS who had not responded to conservative therapy. These patients were randomly assigned to one of two intervention arms. The conservatively treated group received a TA-TOD as well after three months. Change in the Disability of the Arm, Shoulder and Hand (DASH) questionnaire score was the main result. Changes in quality of life ratings, the TOS disability scale, and the Cervical Brachial Symptoms Questionnaire (CBSQ) were secondary outcomes. Three, six, and twelve months after inclusion, outcomes were evaluated.

The key findings of this study were;

In this study, 50 patients were included, 25 in the TA-TOD group and 25 in the group receiving ongoing conservative therapy. 

Following up with 24 and 22 patients, respectively, was finished. TA-TOD: mean 45.15, 95% confidence interval [CI] 38.08 - 52.21; cautious treatment: mean 64.92, 95% CI 57.54 - 72.30; p .001; there was a statistically significant difference in DASH scores at three months. 

Three months following randomization, every patient in the group receiving conservative care submitted an application for surgery. 

For all primary and secondary outcome measures following surgery in the group receiving conservative therapy, there was no statistically significant difference between the groups.

Reference: 

 Goeteyn, J., Pesser, N., Houterman, S., van Sambeek, M. R. H. M., van Nuenen, B. F. L., & Teijink, J. A. W. (2022). Surgery Versus Continued Conservative Treatment for Neurogenic Thoracic Outlet Syndrome: the First Randomised Clinical Trial (STOPNTOS Trial). In European Journal of Vascular and Endovascular Surgery (Vol. 64, Issue 1, pp. 119–127). Elsevier BV. https://doi.org/10.1016/j.ejvs.2022.05.003