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

Abstract

Neurogenic thoracic outlet syndrome treatments have high morbidity and recurrence rates. We present for the first time to our knowledge a minimally invasive spine surgery technique for complete resection of a cervical rib via a costotransversectomy approach. A patient with an 8-year history of progressive thoracic outlet syndrome presented with right C8 pain, weakness, and atrophy of her right forearm and thenar eminence. After neurogenic thoracic outlet syndrome was confirmed via electromyography and imaging revealed bilateral cervical ribs (right more than left), the patient underwent a minimally invasive spine surgery resection of the rib via a costotransversectomy and was discharged home the same day. The patient's pain and weakness gradually improved over a 2-year follow-up period. Resection of a cervical rib via minimally invasive spine surgery costotransversectomy is safe and well tolerated compared with existing surgical treatments such as transaxillary, supraclavicular, and infraclavicular approaches.