{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,26]],"date-time":"2026-09-26T11:00:15Z","timestamp":1790420415119,"version":"4.1.0"},"reference-count":21,"publisher":"MDPI AG","issue":"1","license":[{"start":{"date-parts":[[2023,1,11]],"date-time":"2023-01-11T00:00:00Z","timestamp":1673395200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JPM"],"abstract":"<jats:p>Purpose: The failure rate for operative decompression in neurogenic thoracic outlet syndrome (NTOS) is high compared to more distal nerve compression syndromes, such as cubital or carpal tunnel syndrome. Herein, we aimed to determine if a more radical approach, namely costovertebral exarticulation of the first rib, may improve the postoperative results in patients with NTOS. Methods: From October 2002 to December 2020, 105 operative decompressions in 95 patients were evaluated; in 10 cases, decompressions were performed bilaterally. We presented the clinical outcomes of 59 exarticulations compared to those of 46 conventional resections. Evaluation was performed at a minimum of one year post-operation using the DASH questionnaire. Results: The exarticulation group presented with significantly better clinical outcomes (two-sample t-test assuming unequal variances, p &lt; 0.001). Conclusions: This study showed that significantly better results were obtained when exarticulation of the first rib was performed in patients with NTOS. This finding supports the hypothesis that, in certain cases, the proximal portion of the first rib plays a pivotal role in the pathogenesis of NTOS.<\/jats:p>","DOI":"10.3390\/jpm13010144","type":"journal-article","created":{"date-parts":[[2023,1,11]],"date-time":"2023-01-11T04:45:58Z","timestamp":1673412358000},"page":"144","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":7,"title":["Relevance of Costovertebral Exarticulation of the First Rib in Neurogenic Thoracic Outlet Syndrome: A Retrospective Clinical Study"],"prefix":"10.3390","volume":"13","author":[{"given":"Franz","family":"Lassner","sequence":"first","affiliation":[{"name":"Pauwelsklinik, Boxgraben 56, 52064 Aachen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Becker","sequence":"additional","affiliation":[{"name":"Pauwelsklinik, Boxgraben 56, 52064 Aachen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8241-5351","authenticated-orcid":false,"given":"Andreas","family":"Prescher","sequence":"additional","affiliation":[{"name":"Institute f\u00fcr Molecular und Cellular Anatomy, Aachen University, Pauwelsstr. 30, 52074 Aachen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2023,1,11]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"601","DOI":"10.1016\/j.jvs.2007.04.050","article-title":"Diagnosis of thoracic outlet syndrome","volume":"46","author":"Sanders","year":"2007","journal-title":"J. Vasc. Surg."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"222","DOI":"10.5435\/JAAOS-D-13-00215","article-title":"Thoracic outlet syndrome","volume":"23","author":"Kuhn","year":"2015","journal-title":"J. Am. Acad. Orthop. Surg."},{"key":"ref_3","unstructured":"Birch, R., Bonney, G., and Parry, C.B.W. (1998). Entrapment neuropathy. Surgical Disorders of the Peripheral Nerves, Churchill Livingstone."},{"key":"ref_4","doi-asserted-by":"crossref","unstructured":"Illig, K.A. (2013). Development of consensus-based criteria for NTOS. Thoracic Outlet Syndrome, Springer.","DOI":"10.1007\/978-1-4471-4366-6"},{"key":"ref_5","doi-asserted-by":"crossref","unstructured":"Illig, K.A. (2013). Pathways of care and treatment options for patients with NTOS. Thoracic Outlet Syndrome, Springer.","DOI":"10.1007\/978-1-4471-4366-6"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"91","DOI":"10.1016\/S0749-0712(03)00084-2","article-title":"Complications of surgery for thoracic outlet syndrome","volume":"20","author":"Leffert","year":"2004","journal-title":"Hand Clin."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"99","DOI":"10.1016\/S0749-0712(03)00085-4","article-title":"Thoracic outlet syndrome\u2014Recurrent thoracic outlet syndrome","volume":"20","author":"Atasoy","year":"2004","journal-title":"Hand Clin."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"51","DOI":"10.1067\/mva.2002.123750","article-title":"Management of cervical ribs and anomalous first ribs causing neurogenic thoracic outlet syndrome","volume":"36","author":"Sanders","year":"2002","journal-title":"J. Vasc. Surg."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"505","DOI":"10.1016\/j.amjsurg.2003.12.050","article-title":"Recurrent neurogenic thoracic outlet syndrome","volume":"187","author":"Thomas","year":"2004","journal-title":"Am. J. Surg."},{"key":"ref_10","doi-asserted-by":"crossref","unstructured":"Gelberman, R.H. (1991). Thoracic outlet syndrome. Operative Nerve Repair and Reconstruction, Lippincott.","DOI":"10.1097\/01241398-199207000-00038"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"354","DOI":"10.1097\/00000658-196603000-00005","article-title":"Transaxillary approach to the first rib to relieve thoracic outlet syndrome","volume":"163","author":"Roos","year":"1966","journal-title":"Ann. Surg."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"131","DOI":"10.1055\/s-0033-1348312","article-title":"A hand surgeon\u2019s advanced experience with thoracic outlet compression syndrome","volume":"45","author":"Atasoy","year":"2013","journal-title":"Handchir. Mikrochir. Plast. Chir. Organ Dtsch. Arb. Handchir."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"821","DOI":"10.1016\/j.jvs.2014.11.047","article-title":"Technique of supraclavicular decompression for neurogenic thoracic outlet syndrome","volume":"61","author":"Sanders","year":"2015","journal-title":"J. Vasc. Surg."},{"key":"ref_14","first-page":"66","article-title":"Thoracic outlet syndrome. Results of 282 transaxillary first rib resections","volume":"368","author":"Leffert","year":"1999","journal-title":"Clin. Orthop. Relat. Res."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"390","DOI":"10.1016\/0741-5214(90)90040-H","article-title":"Recurrent thoracic outlet syndrome","volume":"12","author":"Sanders","year":"2013","journal-title":"J. Vasc. Surg."},{"key":"ref_16","doi-asserted-by":"crossref","unstructured":"Illig, K.A. (2013). Surgical techniques: Operative decompression using the supraclavicular approach for NTOS. Thoracic Outlet Syndrome, Springer.","DOI":"10.1007\/978-1-4471-4366-6_29"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"e23","DOI":"10.1016\/j.jvs.2016.04.039","article-title":"Reporting standards of the Society for Vascular Surgery for thoracic outlet syndrome","volume":"64","author":"Illig","year":"2016","journal-title":"J. Vasc. Surg."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"e199","DOI":"10.1097\/PRS.0000000000000828","article-title":"Nerve entrapment: Update","volume":"135","author":"Tang","year":"2015","journal-title":"Plast. Reconstr. Surg."},{"key":"ref_19","first-page":"363","article-title":"Recurrent thoracic outlet syndrome after first rib resection","volume":"79","author":"Roos","year":"1980","journal-title":"Acta Chir. Belg."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"683","DOI":"10.1097\/PRS.0b013e3182402c37","article-title":"Revision surgery for persistent and recurrent carpal tunnel syndrome and for failed carpal tunnel release","volume":"129","author":"Jones","year":"2012","journal-title":"Plast. Reconstr. Surg."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"327","DOI":"10.1001\/archneur.1990.00530030105023","article-title":"The thoracic outlet syndrome is underrated","volume":"47","author":"Roos","year":"1990","journal-title":"Arch. Neurol."}],"container-title":["Journal of Personalized Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2075-4426\/13\/1\/144\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T18:06:53Z","timestamp":1760119613000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2075-4426\/13\/1\/144"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,1,11]]},"references-count":21,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2023,1]]}},"alternative-id":["jpm13010144"],"URL":"https:\/\/doi.org\/10.3390\/jpm13010144","relation":{},"ISSN":["2075-4426"],"issn-type":[{"value":"2075-4426","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,1,11]]}}}