Scalene Muscle Resection Only is Non-Inferior to Traditional Decompression for Neurogenic Thoracic Outlet Syndrome: Results of a Randomized Controlled Trial
Anahita Dua, MD, MS, MBA1,2, Sapan S. Desai, MD, PhD, MBA3
1Medical College of Wisconsin, Milwaukee, WI, USA, 2Stanford Hospital and Clinics, Palo Alto CA , CA, USA, 3Northwest Community Hospital, Arlington Heights, IL, USA.
OBJECTIVES: Traditional decompression for NTOS involves resection of the scalene muscles and a portion of the first rib. The purpose of this study is to compare outcomes of scalene muscle resection only vs. traditional decompression.
METHODS: A randomized controlled study with retrospective chart review was completed. Patients with definitive signs of NTOS were randomized into two groups. The control group was traditional decompression and received both partial first rib and scalene muscle resection; the study group received scalene muscle resection only. Outcomes were evaluated at 1, 3, 6, 12, and 24 months. Length of stay, patient disposition, readmission, return to work, disability, QuickDASH scores were determined.
RESULTS: 37 patients (27 female, average age 37.6 years) underwent 48 procedures for NTOS decompression between August 2014 and September 2017. Patients with VTOS and ATOS were excluded from this study. Of these, 22 procedures were randomized to traditional decompression and 26 to scalene muscle resection only. 32 simultaneous pectoralis minor decompressions were completed. There were no complications and an 8% rate of all-cause 30-day readmission or return to ER. 35 patients were discharged to home, while two were discharged to inpatient rehab. All patients who underwent traditional decompression returned to work at one year, while all patients who underwent scalene muscle resection only were back at work by three months. Operation length, length of stay, and QuickDASH scores are provided in Table 1.
CONCLUSIONS: Partial first rib resection for NTOS can be avoided in properly selected patients with one-year and two-year outcomes that are similar to patients who undergo traditional decompression. Length of stay and return to work is earlier for patients who undergo scalene muscle resection only. 
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