The Posterior Approach

Abstract

In 1962 the posterior approach to the removal of the first rib was proposed by Clagett [1] which he believed gave better access to its posterior end. It is a formidable operation based on thoracoplasty incisions with which the surgeons of the day were very familiar because of its use to treat pulmonary tuberculosis. The operation involved removal of the ribs in order to create a soft tissue collapse over the upper lobe of the lung to promote healing of the tuberculous process. That operation involves a long vertical posterior incision that divides the trapezius, the seratus, and the rhomboid muscles with retraction of the scapula laterally in order to expose the rib cage. Leffert [2] points out that, with respect to the thoracic outlet syndrome, this approach is very bloody and cuts through precisely those muscles one is trying to rehabilitate. Urschel [3] recommended it be used only when an inadequately resected portion of the first rib remains after previous attempt to relieve recurrent symptoms.