# The Morphology of the Dorsal Part of the First Rib in Neurogenic Thoracic Outlet Syndrome Patients: A Retrospective Clinical Study

## TL;DR

This study investigated whether the shape of the first rib differs in patients with neurogenic thoracic outlet syndrome, but found no significant differences that could guide surgical decisions.

## Contribution

The study provides evidence that the dorsal part of the first rib does not differ morphologically in NTOS patients, influencing surgical recommendations.

## Key findings

- No morphological difference was found in the dorsal part of the first rib between NTOS patients and the control group.
- The results suggest that exarticulation of the first rib should be considered when thoracic outlet decompression is indicated.

## Abstract

Background: The recurrence or persistence of symptoms after thoracic outlet decompression (TOD) in patients with neurogenic thoracic outlet syndrome (NTOS) is not uncommon. Some authors have shown significantly better clinical outcomes in patients who underwent TOD with exarticulation of the first rib compared to a group who underwent TOD with preservation of the dorsal portion of the first rib. Several other case series have shown significant improvement after redo surgery with removal of the dorsal first rib remnant. This indicates the importance of the dorsal part of the first rib in NTOS. However, radical exarticulation may not always be necessary. In this study, we tried to answer the question of whether there is a morphological difference in the dorsal part of the first rib in NTOS patients that might help in the diagnosis and treatment of NTOS. Methods: We used the CT data of 21 NTOS patients who underwent TOD surgery and measured the dorsal part of the first rib, then compared them with a quota sample. Results: We found no difference in the dorsal part of the first rib between NTOS patients and the quota sample in our data. Conclusions: As there was no detectable difference, we were not able to use these data to help decide whether exarticulation is necessary in achieving adequate symptom relief. Therefore, we advocate exarticulation of the first rib when TOD is indicated.