Results of the surgical treatment for thoracic outlet syndrome.

Excellent and good results following different operations for TOS are close to 80%, using simple statistics, where results included many patients followed up for only a few months. Using life-table methods, the success rate is 6% to 9% less, close to 70%, at 5 years. The results were virtually identical for anterior and middle scalenectomy, transaxillary first rib resection, and combined supraclavicular scalenectomy and first rib resection. Secondary success, the results of reoperation on patients in whom the first operation failed, improved the results of the primary operation 15% and 17%, respectively, for transaxillary rib resection and anterior and middle scalenectomy. When the initial operation was combined rib resection and scalenectomy, fewer patients underwent reoperation, as only neurolysis could be performed, and the results improved only 3%. A significant variable in results was etiology: Work-related injuries versus non-work-related accidents, usually auto accidents. Results of three independent studies showed better success rates by 13% to 15%, in patients who had non-work-related auto accidents, as compared with work-related injuries.