Introduction

Neurogenic thoracic outlet syndrome (nTOS), the compression of nerval structures at the thoracic outlet, is the most common form of presentation among all forms of thoracic outlet syndromes (Thoracic Outlet Syndrome, 2019; Laulan et al., 2011). Persistent compression of neurogenic structures within the thoracic outlet may lead to a myriad of neurological symptoms impacting individual daily activities, quality of life (QoL), and professional pursuits (Dahlstrom and Olinger, 2012; Illig et al., 2021). The incidence is estimated at 2-3 cases per 100,000 persons/year with a predominance in females (Illig et al., 2021).

Various concepts of diagnosis, classification and therapy are applied to this patient group as management may be multidisciplinary (Dengler et al., 2022a, 2022b; Ferrante, 2012). Recently, a consensus among neurosurgeons on patient management was reached (Dengler et al., 2022a, 2022b), recommending the microsurgical supraclavicular approach without routine first rib resection by most neurosurgeons (Brooke and Freischlag, 2010; Rochkind et al., 2023). The advantageous features of this approach include precise intra-operative diagnosis, secure identification and release of all abnormal anatomical pathologies and comprehensive visualization of the entire plexus without unnecessary morbidity (Scali et al., 2010; Ferrante and Ferrante; Huang and Zager, 2004).

For brachial plexus lesions, a validated QoL outcome instrument such as the EQ-5D-5L is recommended (Feng et al., 2021). However, in nTOS, to date, systematic QoL data based on a validated questionnaire and data on patients' work status are lacking. Therefore, the presented study is the first to assess QoL, based on the validated EQ-5D-5L questionnaire, and return to work for nTOS patients treated by a microsurgical decompression via the supraclavicular approach without routine first rib resection.