Modified Interscalene Approach for Resection of Symptomatic Cervical Rib: Anatomical Review and Clinical Study

Abstract Background Cervical ribs have been reported to be present in about 0.5% of the general population, 10% of patients with cervical rib who are symptomatic usually have neurogenic symptoms, but some have arterial symptoms. In 1861, Coote was the first to excise a cervical rib through a supraclavicular approach and relieved the symptoms of thoracic outlet syndrome. Objectives in this work we address the efficacy and safety of a modification to the supraclavicular approach for resection of symptomatic cervical ribs. Patients and Methods The surgical team in collaboration with anatomist performed cadaveric dissections of the posterior triangle of the neck in the anatomy department, Ain Shams University. A prospective study was done on twenty five patients with moderate to severe neck or upper limb pain; this pain was resistant to medical treatment for at least six months. Pre-operative cervical X-Rays showed cervical ribs. Pain was assessed by using the visual analogue scale (VAS). Electrophysiological tests were performed to confirm the diagnosis. In this study, we performed a modified supraclavicular interscalene approach with resection of the symptomatic rib and without resecting either of the scalene muscles or the first thoracic rib. RESULTS A total of 25 patients were included in this study, the mean age was 36 years (±12 SD), and the mean follow up period was 12.3 months. All patients had a preoperative moderate (28%) to severe (72%) pain. Motor deficits were present in six cases (24%); Sensory manifestations were present in (80%). All patients had a relief of the severe pain at the first post-operative visit in the first week. There were improvements in the motor power in five out of the six patients who had pre-operative motor deficit. Conclusion Modified supraclavicular interscalene approach for resection of symptomatic cervical ribs has shown to be effective in the treatment of neuralgic pain. In comparison to other approaches, it proved to be less invasive, with small transverse incision and without resection of scalenus anterior muscle.