Management of cervical ribs causing neurogenic thoracic outlet syndrome: a ten year experience in the neurosurgery unit, Tikur Anbessa Hospital.

Eighteen cases of cervical Ribs causing numbness, paraesthesia and wasting of hand muscles were seen during the years 1990 to 1999 in neurosurgery unit of Tikur Anbessa, a central, referral teaching hospital. There were thirteen cases of unilateral, and 5 bilateral brachialgic pains M:F = 1:2 with ages range from 15-50 yrs (mean age 32 +/- 4.8 yrs); though it is 3 times common in women specially those with neurologic symptoms. 5 cases didn't have any cervical ribs. All had respective cervical rib resections and scalenotomy done. Paraesthesia and pain were relieved in about 90% of the cases. Cervical rib causing Thoracic Outlet Syndrome (TOS) is a rare condition commonly seen in less than 1% of the population as seen here in 18 cases in 10 years period. The absence of cervical rib doesn't rule out thoracic outlet syndrome as it can be from anomalous first ribs, scalenus anticus syndrome or congenital fibromuscular bands. Surgical excision has a good neurological outcome. No subclavian vessel especially arterial compression cases were seen in this study as cervical ribs can cause neurovascular compression. The diagnostic and therapeutic measures are clearly stated as this syndrome is a diagnostic and treatment challenge to the practicing general surgeons. Accurate diagnosis and proper surgical intervention are very crucial for the good outcome.