Sixtine Chapel syndrome: an additional cervical rib in a 16-year child

Introduction. As a rule, the presence of an additional cervical rib is not accompanied by clinical manifestations, especially in childhood. However, in rare cases, when compression of large vessels by an additional rib occurs, the symptoms can seriously affect the patient’s quality of life. A thorough history collection, clarification of details and an individual approach to each patient with this pathology is extremely important. Goal. To present a description of the surgical treatment of a patient with an additional cervical rib and clinical manifestations associated with compression of the vertebral and subclavian arteries.

Materials and methods. This scientific publication includes clinical experience in the observation and treatment of a boy patient who had compression of two arteries, subclavian and vertebral, due to the presence of a cervical rib. A 16-year patient was comprehensively examined, the following diagnostic methods were investigated: magnetic resonance imaging of the brain and spinal cord, chest X-ray, computed tomography of the neck and chest, ultrasound examination of the vessels of the neck and left upper limb, 3-D modeling of pathology.

Results. According to the results of surgical treatment, it was possible to achieve a satisfactory clinical effect, confirmed by the absence of symptoms and an improvement in the patient’s quality of life in follow-up.

Conclusion. Patients with an additional cervical rib should cause increased alertness, regardless of age and the presence of clinical manifestations. In the described case, it was the integrated approach that made it possible to achieve a clinical effect.

Contribution:
Chelpachenko O.B., Alkhasov A.B. — concept, definition of surgical treatment tactics and operation, writing the text;
Portugal P.M., Strakhov D.A., Ratnikov S.A., Shmykova A.O., Zherdev K.V., Butenko A.S., Abdullayeva L.M. — collecting and processing material, writing the text, editing the text.
All co-authors — approval of the final version of the article, responsibility for the integrity of all parts of the article.

Acknowledgment. The study had no sponsorship.

Conflict of interest. The authors declare no conflict of interest.

Received: September 08, 2025
Accepted: October 02, 2025
Published: October 30, 2025

1. Bianucci R., Lippi D., Perciaccante A., Charlier P., Appenzeller O. Michelangelo Buonarroti (1475–1564) had the deconditioning syndrome while painting the Sistine Chapel ceiling. Med. Hypotheses. 2018; 113: 13–4. https://doi.org/10.1016/j.mehy.2018.02.001

2. Zinovieva G.A., Babanina L.P. Syndrome of the vertebral artery in vertebrogenic pathology of cervical region of the vertebral column. Vestnik Volgogradskogo gosudarstvennogo meditsinskogo universiteta. 2006; 17(1): 9–13. https://elibrary.ru/mvqqmr (in Russian)

3. Lee C.J., Morasch M.D. Endovascular management of vertebral artery disease. Expert Rev. Cardiovasc. Ther. 2011; 9(5): 575–8. https://doi.org/10.1586/erc.11.54

4. Belash V., Zhizhina N., Novoseltsev S. Vertebral artery syndrome: evaluation of osteopathic treatment efficacy. Rossiyskiy osteopaticheskiy zhurnal. 2013; (3-4): 26–35. https://elibrary.ru/rtyhtx (in Russian)

5. Atasoy E. Thoracic outlet compression syndrome. Orthop. Clin. North Am. 1996; 27(2): 265–303. https://doi.org/10.1016/S0030-5898(20)32074-5

6. Durham J.R., Yao J.S., Pearce W.H., Nuber G.M., McCarthy W.J. Arterial injuries in the thoracic outlet syndrome. J. Vasc. Surg. 1995; 21(1): 57–69. https://doi.org/10.1016/s0741-5214(95)70244-x

7. Gruber W.L. Uber die Halsrippen des Menschen mit Vergleichend-Anatomischen Bemerkungen. St. Petersburg; 1869.

8. Murtazina A.F., Nikitin S.S., Naumova E.S. Thoracic outlet syndrome: clinical and diagnostic features. Nervno-myshchnye bolezni. 2017; 7(4): 10–9. https://doi.org/10.17650/2222-8721-2017-7-4-10-19 https://elibrary.ru/ylwrai (in Russian)

9. Lapegue F., Faruch-Bilfeld M., Demondion X., Apredoaei C., Bayol M.A., Artico H., et al. Ultrasonography of the brachial plexus, normal appearance and practical applications. Diagn. Interv. Imaging. 2014; 95(3): 259–75. https://doi.org/10.1016/j.diii.2014.01.020

10. Yarikov A.V., Filyaeva A.S., Kazakova L.V., Smolin A.A., Fraerman A.P., Mukhin A.S., et al. Spinal subclavian theft syndrome: clinical picture, diagnosis and treatment. Zdravookhranenie Yugry: opyt i innovatsii. 2025; 42(1): 17–38. https://elibrary.ru/bernnc (in Russian)

11. Zavaruev A.V. Subclavian steal syndrome. Zhurnal nevrologii i psychiatrii imeni S.S. Korsakova. 2017; 117(1): 72–7. https://doi.org/10.17116/jnevro20171171172-77 https://elibrary.ru/xxdsrf (in Russian)

12. Hempel G.K., Shutze W.P., Anderson J.F., Bukhari H.I. 770 consecutive supraclavicular first rib resections for thoracic outlet syndrome. Ann. Vasc. Surg. 1996; 10(5): 456–63. https://doi.org/10.1007/bf02000592

13. Furushima K., Funakoshi T., Kusano H., Miyamoto A., Takahashi T., Horiuchi Yu., et al. Endoscopic-assisted transaxillary approach for first rib resection in thoracic outlet syndrome. Arthrosc. Sports Med. Rehabil. 2021; 3(1): e155–62. https://doi.org/10.1016/j.asmr.2020.08.019

14. Suzuki T., Kimura H., Matsumura N., Iwamoto T. Surgical approaches for thoracic outlet syndrome: a review of the literature. J. Hand Surg. Glob. Online. 2022; 5(4): 577–84. https://doi.org/10.1016/j.jhsg.2022.04.007

15. Mingoli A., Feldhaus R.J., Farina C., Cavallari N., Sapienza P., di Marzo L., et al. Long-term outcome after transaxillary approach for thoracic outlet syndrome. Arthrosc. Sports Med. Rehabil. 1995; 118(5): 840–4. https://doi.org/10.1016/S0039-6060(05)80274-0

16. Roos D.B. Transaxillary approach for first rib resection to relieve thoracic outlet syndrome. Ann. Surg. 1966; 163(3): 354–8. https://doi.org/10.1097/00000658-196603000-00005