Modified transmanubrial approach for complicated type 1 cervical rib resection requiring subclavian artery reconstruction.

The transmanubrial musculoskeletal sparing approach (TMA) is commonly used for resecting apical lung tumours with vascular involvement. Non-neoplastic conditions which might require surgical exploration of the thoracic outlet include the 'cervical rib', a clinical condition consisting of an additional rib forming above the first rib and growing from the base of the neck just above the clavicle. Type 1 cervical rib-when a complete cervical rib articulates with the first rib or manubrium of the sternum-is the most challenging scenario where the subclavian artery can be damaged by continuous compression due to the narrow space between clavicle, first rib and supernumerary cervical rib, requiring prosthetic reconstruction of the involved tract. Here, we describe a modified TMA in which the incision in the neck is conducted posteriorly to the sternocleidomastoid muscle, thus allowing safe dissection of the superior and middle trunk of the brachial plexus.

Postnatal Evaluation of Cervical Ribs in Control Rats.

BACKGROUND: Cervical ribs in rat fetuses have been widely reported to occur in controls as well as in response to various maternal chemical exposures. However, few evaluations of cervical ribs have been reported in rats postnatally. The available literature has indicated that the postnatal incidences of cervical ribs in control rats are no higher than in perinatal fetuses. METHODS: In a developmental toxicity study in rats conducted by the inhalation route, a control group of 44 time-mated female rats was exposed to filtered air only from gestation day (GD) 6 to 20, and divided into two cohorts. For one cohort, fetuses were removed from dams by laparohysterectomy for skeletal evaluation on GD 21. The other cohort of dams was permitted to deliver, and adult offspring were euthanized on postnatal day 65 for a subsequent postnatal skeletal evaluation of cervical ribs. RESULTS: The incidence of cervical ribs (mean percentage of affected fetuses or adults per litter) was observed to increase during postnatal development, from 1.0% on GD 21 to 12.7% on postnatal day 65. Further evaluation is ongoing to determine whether these observations were attributable to the inhalation exposure conditions used in this study. CONCLUSION: These results, while limited to the evaluation of one skeletal alteration in control rats, support the need for additional research into the area of postnatal development of skeletal abnormalities observed in developmental toxicity studies and the relevance of these skeletal observations to human risk assessment. Birth Defects Research 109:1301-1304, 2017. © 2017 Wiley Periodicals, Inc.

The Epidemiological, Morphological, and Clinical Aspects of the Cervical Ribs in Humans.

A familiarity with the anatomy of some types of bone anomalies is necessary for clinicians involved in many medical areas. The aim of this paper is to review the newest literature concerning the morphology, embryology, clinical image, and therapeutic methods of the cervical ribs in the humans. The incidence of cervical ribs has been found to vary from 0.58% in Malaysian population to 6.2% in Turkish population. Cervical ribs have clinical implications that are generally divided into neurological or vascular. This study is of particular importance for clinicians, as early identification of cervical ribs may prevent life-threatening complications.

Novedades en cirugía de columna vertebral en 2015 / No disponible

En este artículo de revisión, queremos destacar las principales novedades y curiosidades alrededor de la cirugía de columna que se han publicado el año 2015. Aunque, el año pasado no han sido publicadas grandes novedades en nuestra área de estudio, nosotros queremos hacer hincapié en los aspectos que nos han parecido más relevantes sobre cirugía de columna. Dado que la cirugía de columna representa una importante carga asistencial sanitaria y social. Los estudios aquí reflejados intentan dar respuestas a las múltiples demandas pendientes. Así es como abordaremos temas como la artrodesis cervical vs prótesis cervicales, uso local de vancomicina en polvo, vitamina D, mejoras en las técnicas de cementación vertebral, uso de agentes biológicos, escoliosis idiopática del adolescente y factores de riesgo para la cirugía de columna

In this revision article we want to highlight some news and curiosities around the spine surgery published during 2015. Although last year, they have not been published major innovations in spinal surgery, we want to emphasize some aspects that we consider interesting and useful in our working area. Spinal surgery is a major social and health burden, so the studies reflected here attempt to answer outstanding claims. This is how we address issues such as cervical arthrodesis vs cervical prostheses, use of local powder vancomycin, use of vitamin D, improving vertebral cementation techniques, risk factors for spine surgery, use of biological agents and adolescent idiopathic scoliosis

Fusión de 2 costillas como causa de trombosis venosa profunda de miembro superior / Fusion of 2 ribs as the cause of deep vein thrombosis in the arm

No disponible

Crioablación percutánea guiada por imagen para el tratamiento de un plasmacitoma óseo localizado / Percutaneous Image-guided cryoablation for localized bone plasmacytoma treatment

El plasmacitoma óseo (PO) aparece en la mayoría de los pacientes con mieloma múltiple, y se trata de un trastorno sumamente incapacitante. El tratamiento principal del PO es la radioterapia, sin embargo, aunque las tasas de control local son excelentes, se necesitan varias semanas para completar el tratamiento y para que los pacientes noten una mejoría del dolor significativa. Durante la última década, la crioablación percutánea guiada por técnicas de imagen se ha convertido en una alternativa segura y eficaz para el manejo de las metástasis óseas localizadas de tumores sólidos. En el presente trabajo mostramos un PO localizado tratado con éxito mediante este procedimiento. También se destacan algunas de las ventajas potenciales más relevantes que hacen a esta técnica más atractiva que otras técnicas alternativas (AU)

Bone plasmacytoma (BP) occurs in most patients with multiple myeloma and is highly disabling. Radiotherapy is the primary treatment modality for BP and, although local control rates are excellent, several weeks are needed before the treatment is completed and for patients to note significant pain relief. Over the past decade, percutaneous image-guided cryoablation has emerged as a safe and effective alternative in the management of localized bone metastasis in solid tumours. In this report the author's show that a localized BP was successfully treated using this procedure. Furthermore, some of the most relevant potential advantages that makes this procedure more attractive than other alternative techniques are highlighted (AU)

Costilla cervical en el diagnóstico diferencial de una masa supraclavicular / Cervical rib in the differential diagnosis of supraclavicular mass

La costilla cervical consiste en una costilla supernumeraria que surge de la séptima vértebra cervical y termina libremente en el tejido del cuello o se articula con la primera costilla. Puede ser asintomática y diagnosticarse como hallazgo casual en una radiografía de tórax, o bien presentarse con dolor en la región supraclavicular o como complicación en forma de síndrome del desfiladero torácico. A menudo plantea diagnóstico diferencial con masas tumorales malignas, por sus características en la exploración. El manejo suele ser conservador y la intervención quirúrgica se reserva para casos muy sintomáticos o complicados. Presentamos un caso clínico de costilla cervical sintomática y su abordaje desde Atención Primaria (AU)

Cervical rib is a supernumerary rib arising from the seventh cervical vertebra and ends freely in the tissue of the neck or articulates with the first rib. It can be diagnosed as an asymptomatic incidental finding on a chest radiograph or presented with supraclavicular pain or complications as thoracic outlet syndrome. The differential diagnosis often poses malignant tumor masses, because of their characteristics in the physical exam. The management is often conservative reserving surgical intervention for highly symptomatic or complicated cases. We report a case of symptomatic cervical rib and its approach from Primary Care (AU)

Prevalence of cervical ribs and elongated transverse processes in Saudi Arabia.

OBJECTIVE: To describe the prevalence of the full spectrum of transverse process elongation and cervical ribs for the first time in over a decade in a Saudi population, trying to assess any changes in the interim. METHODS: A cross-sectional hospital based study was conducted at King Abdulaziz University Hospital, Jeddah, Saudi Arabia in the 3-month period between October and December 2010. The study comprised a radiologic review of 1,000 consecutive chest radiographs of adults from the digital database looking for the presence of cervical ribs and elongated transverse processes. RESULTS: Our study showed that cervical ribs are present in 3.4% of our population; a female to male ratio was 2.01 to 1. They were bilateral in 41% of those afflicted individuals. Elongated transverse processes were present in 23%. CONCLUSION: The prevalence of cervical ribs and elongated transverse processes in our population is higher than that reported in other populations. It also shows an interim increase in prevalence when compared with a previous study on our population more than a decade back.

A delayed diagnosis that altered the professional orientation of an athlete with upper limb chronic arterial embolization.

BACKGROUND: Vascular disorders of the upper extremity in young and physically active patients present a complex and challenging problem for the treating physician. Initial presentation may often be subtle and the consequences of misdiagnosis, delayed diagnosis or mistreatment can be severe. CASE REPORT: In this report, we discuss a case of a young woman with chronic upper limb ischemia due to an arterial thoracic outlet syndrome in whom even though symptoms persisted over a number of years during which she frequently sought medical consultation, remained undiagnosed until finally presenting with limb-threatening ischemia. Furthermore, due to this delay, the patient was forced to withdraw from her professional carrier in athletics. CONCLUSIONS: A thoughtful and through approach combining the history, physical findings, and use of appropriate diagnostic aids will provide the physician and patient with the greatest opportunity for a satisfactory outcome. Furthermore, a delay in definitive treatment may not only cause health deterioration, but may also incur social, economic and occupational consequences.

Anatomical relationship of Roos' type 3 band and the T1 nerve root.

BACKGROUND: The most common clinical presentation of thoracic outlet syndrome stems from compression of the lower trunk of the brachial plexus or ulnar nerve. A plethora of anatomical variations have been implicated in the cause of thoracic outlet syndrome. Roos' identification and classification of scalene muscle and fibrous bands have added an additional dimension to understanding its cause and subsequent treatment. Understanding the anatomy and relationship of this band with the lower trunk of the brachial plexus is of paramount importance. METHODS: As part of the authors' long-term study of the type 3 band in relation to the brachial plexus, 70 embalmed cadavers were dissected to yield 100 first thoracic ribs. Fibrous bands, when present, were studied in relation to the brachial plexus. RESULTS: A fibrous band consistent with Roos' type 3 was identified and found to occur in 35 percent of first ribs and 41 percent of cadavers. The mean size was 3.45 × 0.27 cm. Origins and insertions are described. Contrary to Roos' own description, however, the authors observed that Roos' type 3 band was anterior to the T1 nerve root, creating a tunnel through which the T1 nerve root must pass before joining the C8 nerve root. CONCLUSIONS: The authors believe that the type 3 band, when present, can create a tunnel that compresses the T1 nerve root against the first rib, potentially predisposing susceptible individuals to thoracic outlet syndrome. Clinical studies are needed to determine whether correlations between type 3 bands and thoracic outlet syndrome exist.

Magnetic resonance neurography-surgical correlation of neurologic thoracic outlet syndrome.

For evaluation of thoracic outlet syndrome (TOS), 3 Tesla magnetic resonance neurography (MRN) is being increasingly used. The authors report the findings on 3 T MRN with surgical correlation in a rare case of neurologic TOS caused by anomalous costal pseudoarthrosis.

Type III Klippel-Feil syndrome: case report and review of associated craniofacial anomalies.

Klippel-Feil syndrome (KFS) is a complex syndrome of osseous and visceral anomalies that include the classical clinical triad of short neck, limitation of head and neck movements and low posterior hairline. It may also be associated with anomalies of the genitourinary, musculoskeletal, neurologic and cardiac systems. We report a case of type III KFS with associated rib anomalies such as cervical rib, fusion and bifid ribs, scoliosis and fused crossed renal ectopia. The aim of this paper was to summarize all craniofacial anomalies that occur in association with KFS, so that clinicians would be aware of them during diagnosis and treatment planning.