Safety and efficacy of posterior upper rib excision and decompression (PURED) technique for surgical treatment of neurogenic thoracic outlet syndrome

There are several approaches used for surgical treatment of neurogenic thoracic outlet syndrome (n-TOS). The posterior upper rib excision and decompression (PURED) technique is a novel technique which was developed and used by the author for the last eight years. The purpose of this paper is to report clinical outcomes of patients treated with this approach. All patients with n-TOS operated by single surgeon from 2015 to 2023 were retrospectively analyzed. Demographic, clinical, radiological, surgical and postoperative data were collected and reported with emphasis on efficacy and complications. The surgical success was evaluated subjectively as excellent, good, fair, poor and bad. Radiological data were analyzed to assess the extent of accessory/first rib removal. 80 procedures were performed in 61 patients with mean follow up 1153 (87-3048) days. 60.7% of patients were females and 39.3% were males. In 11 cases (18%) causative factor was bone abnormality. Two patients were previously operated at another centers (3.3%). Total mean subjective improvement rate was 91.5%. 55 patients reported “excellent” (>75%) and 6 “good” improvements (50-75%); no fair, poor and worse outcomes were reported. Patients reporting “good” outcome had statistically significant shorter follow ups than “excellent” group (p