Surgical Management of Neurogenic Thoracic Outlet Syndrome: Exploring the Efficacy of the Posterior Intermuscular Approach in Cases Involving Bone Anomalies

Abstract

BACKGROUND AND OBJECTIVES: This article presents a cohort study focusing on neurogenic thoracic outlet syndrome (NTOS) caused by bone anomalies in the cervicothoracic region, specifically the extraforaminal area and the scalene triangle. Our aim was to contribute to understanding NTOS diagnosis and management, particularly in patients with bone anomalies, and to highlight the potential benefits of the posterior intermuscular approach as a surgical option in this particular patient group. METHODS: We retrospectively evaluated the patients who underwent surgery for NTOS with accessory ribs or an elongated cervical vertebrae 7 (C7) transverse process (n = 9). Patients' clinical data, preoperative neurophysiological tests, cervical computed tomography (CT) scans, CT angiography, and postoperative cervical CT scans were reviewed. A single experienced surgeon used the posterior intermuscular approach on all patients. The accessory rib and/or elongated C7 transverse process and fibrous bands were removed; C7, C8, and T1 branches of the plexus were decompressed; and neurolysis was performed. Quality of life, a functional outcome, was measured by using Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire, and pain was measured using visual analog scale scores. RESULTS: The mean follow-up time after surgery was 7 months (range: 4-10 months). Before surgery, the mean DASH score was 55.8 ± 5.6. At the 3- and 6-month postoperative evaluations, the mean DASH scores decreased to 15.7 ± 5.8 and 15.4 ± 5.7, respectively. The mean visual analog scale score was 8.2/10 before surgery and decreased to 2.4/10 and 2.1/10 at the 3- and 6-month postoperative evaluations, respectively. All patients experienced good or excellent recovery at the 3- and 6-month postoperative evaluations. CONCLUSION: Cervicothoracic extraforaminal area may be the primary site of nerve compression in NTOS, and posterior decompression using the posterior intermuscular approach can provide efficient access to extraforaminal nerve roots.