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Objective: The presence of a cervical rib in 1% of the general population can often be symptomatic, causing neurogenic thoracic outlet syndrome (nTOS). Surgical treatment has been most commonly described through a supraclavicular incision or a combination of supraclavicular (SC) and transaxillary (TA) dissections. In an effort to avoid a supraclavicular incision, particularly in young patients, completely transaxillary cervical rib resections were done and their outcomes evaluated.
Methods: In a single center retrospective review, we analyzed peri-operative and outcome data on subjects undergoing cervical rib resection for nTOS between 1994 and 2013.
Results: Of the 75 operations performed for nTOS, 40% (30 procedures in 29 patients) required resection of cervical ribs in 25 women (87%) and 4 men (13%). Mean age was 37 (13-68 range). The first and cervical ribs were removed in 24 cases, whereas only the cervical was resected in 6. Scalenetectomy was performed in all patients. 13 (43%)procedures were done with a supraclavicular only (SC) approach, 9 (30%) with a transaxillary only (TA) approach, and 8 (27%). with both incisions (TA+ SC). The most common perioperative complication was pneumothorax occurring in 1 (8%) of SC, 4 (44%) of TA, and 1 (13%) of the TA+ SC group. There were no instances of brachial plexus or other nerve injury. Incidence of persistent nTOS symptoms occurred in 3 (23%) of SC patients, 1 (13%) TA patient, and 2 (25%) TA + SC patients. (p=NS) Recurrence of symptoms was noted in one patient (8%) in the SC group at 1 year follow up. No patient required operative reintervention.
Conclusions: Resection of cervical ribs, often in addition to first ribs, in treatment of nTOS can be safely done through SC, TA or a combined approach. In young patients, a TA incision may be considered to avoid a neck incision, with similar outcomes to alternate approaches.