title: Modified Interscalene Approach for Resection of Symptomatic Cervical Rib: Anatomic 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.
  
  
  OBJECTIVE
  In this study, we address the efficacy and safety of a modification to the supraclavicular approach for resection of symptomatic cervical ribs.
  
  
  METHODS
  The surgical team in collaboration with an anatomist performed cadaveric dissections of the posterior triangle of the neck in the Department of Anatomy, Ain Shams University. A prospective study was performed of 25 patients with moderate to severe neck or upper limb pain; this pain was resistant to medical treatment for at least 6 months. Preoperative cervical radiography showed cervical ribs. Pain was assessed by using the visual analog scale. Electrophysiologic 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 standard deviation), and the mean follow-up period was 12.3 months. All patients had moderate (28%) to severe (72%) preoperative pain. Motor deficits were present in 6 cases (24%); Sensory manifestations were present in 80%. All patients had a relief of severe pain at the first postoperative visit in the first week. There were improvements in the motor power in 5 of the 6 patients who had preoperative motor deficit.
  
  
  CONCLUSIONS
  A modified supraclavicular interscalene approach for resection of symptomatic cervical ribs has been shown to be effective in the treatment of neuralgic pain. Compared with other approaches, it proved to be less invasive, with small transverse incision and without resection of scalenus anterior muscle.
authors.affiliation: Department of Neurosurgery, Ain Shams University, Abbasseya, Cairo, Egypt. Electronic address: wghany@gmail.com.
authors.forename: Walid
authors.initials: W
authors.lastname: Abdel Ghany
authors.affiliation: Department of Neurosurgery, Ain Shams University, Abbasseya, Cairo, Egypt.
authors.forename: Mohamed A
authors.initials: MA
authors.lastname: Nada
authors.affiliation: Department of Neurosurgery, Ain Shams University, Abbasseya, Cairo, Egypt.
authors.forename: Ahmed F
authors.initials: AF
authors.lastname: Toubar
authors.affiliation: Department of Neurosurgery, Ain Shams University, Abbasseya, Cairo, Egypt.
authors.forename: Ahmed E
authors.initials: AE
authors.lastname: Desoky
authors.affiliation: Department of Anatomy, Ain Shams University, Abbasseya, Cairo, Egypt.
authors.forename: Hesham
authors.initials: H
authors.lastname: Ibrahim
authors.affiliation: Department of Physical Medicine and Rehabilitation, Ain Shams University, Abbasseya, Cairo, Egypt.
authors.forename: Marwa A
authors.initials: MA
authors.lastname: Nassef
authors.affiliation: Department of Anaesthesia and Intensive Care, Ain Shams University, Abbasseya, Cairo, Egypt.
authors.forename: Mostafa G
authors.initials: MG
authors.lastname: Mahran
mesh_terms: D000293:Adolescent; D000328:Adult; D066193:Cervical Cord / Q000601:surgery*; D057070:Cervical Rib / Q000601:surgery*; D002573:Cervical Rib Syndrome / Q000000981:diagnostic imaging / Q000601:surgery*; D019299:Decompression, Surgical / Q000379:methods*; D005260:Female; D006801:Humans; D021621:Imaging, Three-Dimensional; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012086:Reoperation; D015898:Tomography Scanners, X-Ray Computed; D016896:Treatment Outcome; D064232:Visual Analog Scale; D055815:Young Adult
keywords: Brachial plexus; Cervical rib; Radiculopathy; Thoracic outlet syndrome