Surgical treatment of cervical rib syndrome

Sultanov D.D., Usmanov N.U., Kurbanov N.R, Abdulloev N.K.
Department of Vascular Surgery, Republican Scientific Centre for Cardiovascular and Thoracic Surgery, Dushanbe, Tajikistan

The authors report herein the results of examination and surgical management of fifty-one patients presenting with cervical ribs. Of these, there were 33 women. Compression of the neurovascular bundle (NVB) was found to be caused by a supplementary cervical rib in twenty-three patients while in the remaining 28 patients by a rudimentary cervical rib. Twenty-two patients were found to have clinical manifestations of Raynaud's syndrome.

The presence of abnormal cervical ribs was determined roentgenologically. All the patients with rudimentary cervical ribs and twelve of the 23 patients with supplementary cervical ribs were diagnosed as having bilateral abnormalities.

Haemodynamics was studied by Doppler ultrasonography revealing blood flow impairments in upper-limb arteries in Edson's test in patients with supplementary cervical ribs and Raynaud's syndrome. In rudimentary cervical rib – only in the development of Raynaud's syndrome.

The nervous function was studied by means of electroneuromyography (ENMG). All the patients were diagnosed as having a significant decrease in both motor and sensitive nervous conductivity of the radial and median nerves.

All patients were operated on under endotracheal anaesthesia. Decompression operations were carried out in fifty-one patients, with selective thoracocervical sympathectomy performed in twelve. For treating rudimentary cervical rib, we worked out a combined method of an ope ative intervention. Analysing the obtained surgical outcomes showed the following: forty-four patients (86.3%) endured the operation with no complications. Intraoperative complications were noted to occur in 5.9% of patients and complications in the immediate postoperative period were observed to develop in 7.8% of patients. All the encountered complications turned out transient, easily amendable to treatment, and did not influence the final outcome of the operation. In the remote period up to 5 years positive results remained in 90.2% of the patients.

KEY WORDS: thoracic outlet syndrome, cervical rib, diagnosis, surgical management.

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