Minimally Invasive Resection of Symptomatic Cervical Rib for Treatment of Thoracic Outlet Syndrome

Hawks, Charlotte; Herrera-Nicol, Sarah; Pruzansky, Mark E.; Jenkins, Arthur L.

doi:10.1016/j.wneu.2020.03.049

Cited by 4 publications

(5 citation statements)

References 9 publications

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“…Hawks et al. 14 reported a successful minimally invasive resection of the first rib through a costotransversectomy for a patient with nTOS.…”

Section: Discussionmentioning

confidence: 99%

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Minimally invasive resection of a prominent transverse process in neurogenic thoracic outlet syndrome: new application for a primarily spinal approach. Illustrative case

Hohenhaus,

Lambeck,

Kremers

et al. 2024

Journal of Neurosurgery: Case Lessons

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BACKGROUND The optimal surgical approach to treat neurogenic thoracic outlet syndrome (nTOS) depends on the individual patient’s anatomy as well as the surgeon’s experience. The authors present a minimally invasive posterior approach for the resection of a prominent transverse process to reduce local muscular trauma. OBSERVATIONS A 19-year-old female presented with painful sensations in the right arm and severe fine-motor skill dysfunction in the right hand, each of which had been present for several years. Further examination confirmed affected C8 and T1 areas, and imaging showed an elongated C7 transverse process displacing the lower trunk of the brachial plexus. Decompression of the plexus structures by resection of the C7 transverse process was indicated, owing to persistent neurological effects. Surgery was performed using a minimally invasive posterior approach in which the nuchal soft tissue was bluntly dissected by dilatators and resection of the transverse process was done microscopically through a tubular retractor. The postoperative course showed a sufficient reduction of pain and paresthesia. LESSONS The authors describe a minimally invasive posterior approach for the treatment of nTOS with the aim of providing indirect relief of strain on brachial plexus structures. The advantages of this technique include a small skin incision and minor soft tissue damage.

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“…Hawks et al. 14 reported a successful minimally invasive resection of the first rib through a costotransversectomy for a patient with nTOS.…”

Section: Discussionmentioning

confidence: 99%

“…4 Reports concerning minimally invasive posterior procedures are rare. Hawks et al 14 reported a successful minimally invasive resection of the first rib through a costotransversectomy for a patient with nTOS.…”

Section: Discussionmentioning

confidence: 99%

Minimally invasive resection of a prominent transverse process in neurogenic thoracic outlet syndrome: new application for a primarily spinal approach. Illustrative case

Hohenhaus,

Lambeck,

Kremers

et al. 2024

Journal of Neurosurgery: Case Lessons

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show abstract

“…6,7 Although a conservative treatment should be first in line of therapy, surgical decompression to remove the transverse megaapophysis is recommended when conservative management has failed. 7,8 conclusIon Neurogenic thoracic outlet syndrome is a well-described disorder typically caused by the presence of fibrous and muscular bands, variations in the insertion of the pectoralis minor, the presence of neural structures that follow an atypical course, the existence of a cervical rib, trauma injuries, repetitive arm and shoulder movements and activity, such as from playing certain sports or others causes that can alter the upper thoracic aperture.…”

Section: Discussionmentioning

confidence: 99%

Cervical Transverse Mega-apophysis: A Rare Cause of Plexopathy

Ferrer¹,

Álvarez²,

Penanes³

2021

International Journal of Head and Neck Surgery

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Aim This article aims to describe the case of a 43-year-old male with a neurogenic thoracic outlet syndrome caused by a C7 transverse mega-apophysis. Background Cervical transverse mega-apophysis, transverse apophysomegaly, or elongation of the transverse vertebral process represents a variation of normal skeletal anatomy. This variation has been little studied and its prevalence in the population is unknown because it often exists without symptoms. It is estimated that less than 10% of cases are symptomatic. Case description We present a rare case of a man with a neurogenic thoracic outlet syndrome (in this case, a left plexopathy) caused by a cervical transverse mega-apophysis. After surgical intervention, the patient improved and after a 1-year follow-up, he remained asymptomatic. Conclusion Even though some authors describe cervical pain associated with this condition, we found very few data regarding plexopathy or other neurological symptoms caused by a cervical transverse apophysomegaly. How to cite this article Ferrer P, Álvarez AS, Penanes JR. Cervical Transverse Mega-apophysis: A Rare Cause of Plexopathy. Int J Head Neck Surg 2021;12(1):40–42.

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“…For patients with persistent symptoms, management includes CR resection. 96 Combined first rib resection along with CR resection will provide more space for the neurovascular bundle and thereby lower chance of symptom recurrence. 96 For patients with incidentally discovered CR, counselling should be provided about the occurrence of TOS.…”

Section: Cervical Ribsmentioning

confidence: 99%

Compressive lesions of the head and neck: Common and uncommon must-know entities

et al. 2023

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There are many lesions that cause compression of nerves and vessels in the head and neck, and they can often be overlooked in the absence of adequate history or if not suspected by the radiologist. Many of these lesions require a high index of suspicion and optimal positioning for imaging. While a multimodality approach is critical in the evaluation of compressive lesions, an MRI utilizing high-resolution (heavily weighted) T2-weighted sequence is extremely useful as a starting point. In this review, we aim to discuss the radiological features of the common and uncommon compressive lesions of the head and neck which are broadly categorized into vascular, osseous, and miscellaneous etiologies.

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Minimally Invasive Resection of Symptomatic Cervical Rib for Treatment of Thoracic Outlet Syndrome

Cited by 4 publications

References 9 publications

Minimally invasive resection of a prominent transverse process in neurogenic thoracic outlet syndrome: new application for a primarily spinal approach. Illustrative case

Minimally invasive resection of a prominent transverse process in neurogenic thoracic outlet syndrome: new application for a primarily spinal approach. Illustrative case

Cervical Transverse Mega-apophysis: A Rare Cause of Plexopathy

Compressive lesions of the head and neck: Common and uncommon must-know entities

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