LAUSR

BACKGROUND Neurogenic Thoracic Outlet Syndrome (nTOS) treatments have high morbidity and recurrence rates. We present a minimally invasive spine surgery (MISS) technique for complete resection of a cervical rib via a costotransversectomy approach, not previously described. CASE DESCRIPTION We report on a patient with 8 years of progressive TOS with right C8 pain, weakness, and atrophy of her right forearm and thenar eminence. After nTOS was confirmed via electromyography (EMG) and imaging revealed bilateral cervical ribs (right more than left), the patient underwent a minimally invasive spine surgery (MISS) resection of the rib via a costotransversectomy and was discharged home the same day. The patient gradually improved in her pain and weakness over a two year follow up period. CONCLUSIONS Resection of a cervical rib via MISS costotransversectomy is safe and well tolerated, compared to existing surgical treatments such as trans-axillary, supra-clavicular, and infraclavicular approaches.