Surgical decompression in cervicothoracic brachial spinal cord syndrome secondary to cervical spine

Cervicothoracic brachial outlet syndromes (CTBS) include all clinical manifestations related to intermittent or permanent compression of the trunks of the brachial plexus or of the subclavian artery or vein in this crossing. Five anatomical spaces follow one another, which determine areas of narrowing and thus potential compression. Within the SDCTB, there are many anatomical variations, the best known of which, already classified by Gruber in 1869, includes the different shapes of the cervical ribs. However, there are other anomalies involving the soft tissues of this confined space. SDCTB is difficult to diagnose due to the intertwining of vascular and nervous symptoms. A thorough knowledge of the anatomy is necessary to clarify the mechanisms and levels of injury. Complementary examinations may be limited to echodoppler and a precise electromyographic study pending progress in magnetic resonance imaging. TBISS are classified as definite or very probable TBISS (neurological, arterial, or venous) and composite, possible or unlikely TBISS (including the frequent neurological TBISS with subjective manifestations). Treatment relies primarily on well-conducted physiotherapy/physiotherapy and postural efforts by the patient. Surgical release of compression is indicated for well-defined SDCTB that is complicated or resistant to physiotherapy.