Outcomes after treatment of NTOS

The role of surgical therapy for neurogenic thoracic outlet syndrome (NTOS) is not always straightforward, but for most who treat this disease, such intervention remains a mainstay of therapy. Assessing outcomes of treatment for NTOS, especially compared to the vascular forms of the syndrome, has been difficult due to a lack of reliable objective criteria to both diagnose the syndrome and to track outcomes. Methods utilized include subjective reporting, visual analogue scales, patient satisfaction scores, and functional or quality of life questionnaires, none of which have reached acceptance as a gold standard for following the outcomes of NTOS patients. Likewise, to select the NTOS patients most likely to benefit from surgical decompression, a number of factors can be considered, including presenting and confounding symptoms, patient demographics, duration of symptoms and response to anterior scalene muscle blockade. Overall, most series have demonstrated that with assiduous patient selection, surgical decompression for NTOS is effective, with one meta-analysis demonstrating that 70% of patients have a meaningful improvement in symptoms along with a low risk of complications. With these data in mind, for properly selected NTOS patients surgical decompression remains a safe and effective therapeutic option.