True neurogenic thoracic outlet syndrome: late outcomes from a surgical series

• Published in: Acta neurochirurgica 2022-10, Vol.164 (10), p.2673-2681
• Main Authors: Martins, Roberto Sergio, Zaccariotto, Monise, Siqueira, Mario Gilberto, Heise, Carlos Otto, Neto, Hugo Sterman, Teixeira, Manoel Jacobsen
• Format: Article
• Language: English
• Subjects: Decompression, Surgical - methods; Hand - surgery; Humans; Interventional Radiology; Medicine; Medicine & Public Health; Minimally Invasive Surgery; Neuralgia; Neurology; Neuroradiology; Neurosurgery; Original Article; Patients; Retrospective Studies; Surgery; Surgical Orthopedics; Thoracic Outlet Syndrome - diagnosis; Thoracic Outlet Syndrome - surgery; Thorax; Treatment Outcome; Upper Extremity - surgery
• ISSN: 0942-0940; 0001-6268; 0942-0940
• DOI: 10.1007/s00701-022-05319-2

Background True neurogenic thoracic outlet syndrome (TNTOS) is rare, and evaluation of surgical treatment is limited to a few studies in the literature. The purpose of this study is to present the results from a surgical series of 21 patients with TNTOS. Methods Retrospective analysis on 21 patients diagnosed with TNTOS who underwent surgery. Demographic data and neurological status were characterized, and patients were classified in accordance with a pre-established scale for assessing the severity of hand impairment before and after surgery. Neuropathic pain was assessed using a visual analogue scale (VAS) and functional disability was quantified using the QuickDASH questionnaire. The results from before and after surgery were compared using the Wilcoxon test, and the significance level was taken to be 5%. Results There was a significant difference in VAS values from before to after the operation (Wilcoxon test: p  = 0.0001; r  = 0.86). Most patients (90%) improved after surgery, and in 85% of these patients, the VAS improvement was greater than 50%. Improvement in hand function occurred in seven patients (33.3%), and in most of these cases (28.6%), this improvement was classified as mild. Most patients (93.3%) showed moderate to very severe functional disability at the end of the follow-up. Conclusion After surgery, only one-third of the cases showed improvement in motor function and most patients had significant functional disability. However, the improvement regarding pain was significant. Surgery to control this symptom should be recommended, even in cases of late presentation and severe motor impairment.