SO27. First Rib-Sparing Vs. Rib Resection in Thoracic Outlet Syndrome: Functional Outcomes in 105 Patients

PURPOSE: Thoracic outlet syndrome (TOS) is a potentially debilitating condition associated with upper extremity paresthesia, pain, and weakness. Surgical treatment traditionally included resection of the first rib during thoracic outlet decompression (TOD). A novel rib-sparing technique involves anterior/middle scalenectomy, plexus neurolysis, and pectoralis minor release. We compared outcomes between TOD techniques in a large patient population. METHODS: A single-institution retrospective chart review was performed between January 2017 and September 2024. Patients were included who had TOS and surgical treatment via first rib resection or rib-sparing TOD. Statistics were performed using Fisher Exact and Welch’s two-tailed t-test. RESULTS: 105 patients (54.28% female, median age 39 years) met inclusion criteria. Eighteen underwent decompression with rib resection versus 87 who underwent a rib-sparing technique. Complications were seen in 5.5% of the rib resection group versus 4.5% in the rib-sparing group (p=1.0). Regardless of surgical technique, patients had motor, sensory, and/or pain improvement. The average improvement in MRC grade across muscle groups was similar between cohorts (p=0.34). CONCLUSION: TOS is a complex disorder with no gold standard treatment. We show patients who underwent rib-sparing TOD had similar functional outcomes to those who underwent rib resection but had lower overall complication rates, most notably of complications involving violation of the pleura. Future prospective studies are warranted to establish a standard of care for this challenging disorder.