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golfnut
05-07-2010, 04:43 PM
Do most spinal fusion surgeries on those with rib humps take care of the rib hump when the spine is rotated or is a separate thoracoplasty surgery sometimes needed? I hate my rib hump even more than my crooked back. I read on the forum that Janet noticed her rib hump came back many months after surgery with Dr. Lenke. I've heard he doesn't like to do the thoracoplasty. I don't want to think about having a separate surgery a year or so later. Can it be done shortly after the spinal fusion surgery? I figure I'm going to be in pain anyway and I'd really like to have a nicer lookiing back after going through the surgery. I know I will be really disappointed if the surgery doedn't take care of the rib hump, too.

joyfull
05-07-2010, 05:35 PM
Hi Karen. I've heard that the recovery from the thoracoplasty is very painful, and that the removal of a rib can cause other problems. I know that Dr. Boachie doesn't do it either, as far as I know. Even Janet said that her rib hump is not as bad as it was before the surgery. I also have a prominent rib hump with my 90 degree thoracic curve; my hump has shifted over to the side as has my torso in recent years. I'm hoping for some good correction from Dr. Lonner; he told me about 50%. Hopefully some people here will know more about it. Joy

doodie
05-07-2010, 05:52 PM
Hi Karen -

I think perhaps thoracoplasties are performed when the rib hump is not expected to be significantly reduced from regular spinal surgery. If after the original surgery that rib hump has not been reduced, a second procedure could be done, using the original posterior incision site.

I did not need a 2nd procedure to reduce my rib hump (thoracic). Four osteotomies were done at T6-7, 7-8, 8-9, 9-10 to allow for the best possible correction as that curve was very stiff. Remember that a scoliotic spine is 3 dimensional - the curves are not only straightened but de-rotated as well.

Anytime you cut into a rib there is going to be pain upon inhalation and exhalation. (similar to a broken rib) Plus possibly lung complications. Of course any of these surgeries are not without their complications....I think recovery time is about 3 months and about the same time frame for rib re-growth.

LindaRacine
05-07-2010, 10:30 PM
Thoracoplasties are pretty rare in terms of scoliosis surgeries these days. The derotation of the spine that takes place during surgery significantly reduces the rib hump. I've seen patients whose back appear to be completely normal after surgery.

Pooka1
05-07-2010, 11:19 PM
Thoracoplasties are pretty rare in terms of scoliosis surgeries these days. The derotation of the spine that takes place during surgery significantly reduces the rib hump. I've seen patients whose back appear to be completely normal after surgery.

This is also my understanding.

Pedicle screws allow for very extensive derotation and even complete derotation. My one daughter who was quite rotated was quite UNrotated during surgery. The other daughter never had much rotation to speak of although she was 57* on the table, virtually the same as the first kid who was 58* at surgery.

I am always surprised to hear about adults and especially kids having thoracoplasties.

Singer
05-08-2010, 07:33 AM
I had a thorocoplasty with my fusion for two reasons: to remove the rib hump and to provide crushed bone for the fusion. My cosmetic results are fantastic, but I have a lot of scar tissue and tenderness around the site and it was a very tough incision to recover from. There's also been some reduction in lung capacity, which only bothers me when I'm singing -- but for me, that's a big deal.

RitaR
05-08-2010, 05:09 PM
I had a full fusion to pelvis and was at 95 degrees prior to surgery, approx 25 degrees (I think - find out for sure after my postop appt) following surgery. I had a significant rib hump and my spine was significantly rotated prior to surgery. However, Dr. Lenke never mentioned anything to me about a thoracoplasty - I'm not relishing the thought of more surgery EVER in my future days..... Ha! Ha!

kennedy
05-08-2010, 08:36 PM
my surgeon done both a spinal fusion and a thoracoplasty doring the same surgery for the same two reasons: to remove the rib hump and to provide crushed bone for the fusion

Back-out
05-08-2010, 09:19 PM
As I understand it even if de-rotation is achieved during surgery, often re-rotation occurs - years afterward, for some. That sadly, is not as rare as we'd like to assume. I think bone and cartilage have a "memory". I don't know about the effect of pelvic fixation Linda speaks of. It would be nice to think that's a game changer.

A recent article I studied, emphasized the lamentable lack of statistics on outcomes in scoliosis surgery. There's a lot of criticism here (from what I'll call the "only surgery is reliable" camp) about the lack of reliable outcome based research on other modalities.

Unfortunately, though, surgeons themselves do not report consistently, least of all their failures (if one can call them that - they may or may not have been inevitable). Longitudinal studies are few in number and I don't find many analyses done so one can compare them, in an apples to apples way. The SRF only began mandatory reporting of serious complications, including death, a few years ago. Also, few studies go beyond five years even though complications like scoliosis itself, often occur only after many years.

Surgeons have egos, and they've gotten in the way of scholarship and optimal progress. Hopefully, under Lenke's leadership, this will change in favor of a more scientific approach. (His term will last six years, BTW - a gain for patients as a whole, but a sad loss for his own clinical practice).

I have developed a marked rib hump. As so many report about migrating twists and turns, mine seemed to appear when my sharp, boring thoracic pain upon walking (unsupported!) disappeared. (Did leaning over shopping baskets in the Mall and elsewhere do it? :confused: Could I have avoided it"?)

Anyhow, I'm thinking this something one with a hump, really needs to consider in choosing a surgeon. Some, even good ones, may not do as well with this problem as others. It's really a sub-specialty. Even if I'm momentarily disappointed, I feel more comfortable with a surgeon who gives me odds, not guarantees (or anything sounding like one).

The first surgeon of three I just saw, said (dare I say, "blithely?") that, "of course", derotating me would get rid of the hump.

Maybe he thought it was reassuring, (it WAS) but OTOH maybe it was salesmanship. My first tendency was to go with #1. He wants to start the fusion six vertebrae lower, didn't speak of complications or more surgery, and waved away my rib hump. I left his office floating on air, feeling all I needed was to await the touch of his magic wand.

The other two, older and more experienced, gave me more warnings.

Don't feel I've found "Dr. Right" yet, but I am planning to make more specific inquiries about rib humps (ARE there any other kind??). How many they've treated, what to expect as a recurrence risk - lastly, their personal success rate. (One problem is, besides that they can tell me anything - it takes a while to revert).

If they "wave away" such concerns, it will NOT inspire confidence.

lray
05-08-2010, 10:13 PM
Karen - It will depend on the surgeon on whether he/she would recommend a thoracoplasty. Many surgeons do not have experience performing the procedure, and others feel that the de-rotation of the spine along with the fusion will reduce the hump enough. Some surgeons, like mine, perform them often. He has recommended that I should consider it, and I am. I will be speaking with a couple of his patients about their experience before I make my final decision. I'm not looking forward to more pain, but even more so, I do not want to go through this serious surgery and still be with a rib hump. No how, no way!

Shari
05-09-2010, 11:56 PM
Karen, I had a rib, five lumbar discs and some hip bone removed, replaced with a cage and crushed up bone. I had a very visable rib hump and wore my clothes so no one could see it. I have no rib hump now.

This is a story that I don't think I've told anyone but one of my sisters. I was going to play in a golf scramble and having to bend over to putt, I didn't want anyone to see my hump, so I had my sister mold a washcloth to match the hump, then we used duck tape to hold it in place. It worked, but I damn near passed out from the heat and the tape being a little too tight.

The things we do to hide this condition is sometimes hard to believe,
Shari

golfnut
05-10-2010, 09:59 AM
Thanks, to all of you for your replies. Since I play golf almost every day in the summer, I am constantly bending over to put the tee in the ground, putt, or just taking the normal swing with people standing behind me where even with loose fitting shirts, the rib hump is obvious. I just got off the phone with Dr. Lenke's office. Kelly thought the pulminary functioning of the lungs prior to surgery would have a lot to do with whether a thoracoplasty could be done, but that I needed to talk to Dr. Lenke at my pre-op in September. Thanks, again.

golfnut
05-10-2010, 01:36 PM
Shari,
I loved your story of the washcloth and duct tape. Too funny! I have even thought of doing something similar but never did.

Peachy
05-24-2010, 05:53 PM
Joy is mistaken when she says Dr. Boachie doesn't perform thoracoplasties. I had asked him if the de-rotation from my surgery would take care of my terrible rib hump, and he told me that it would improve the hump, but that it would still be quite obvious. He actually recommended the thoracoplasty, not only for the cosmetic reason (which was VERY important to me), but also because, as Singer said, he uses the rib bone for part of the fusion bone. I agree with Iray that whether or not a surgeon does a thoracoplasty depends a lot on his experience and (my word) ability.

My surgery was done by Dr. B. on 1-20-09. There was no extra scar from the thoracoplasty; he just went in through the long posterior incision. I'm fused T-3 to S-1. I can tell you that I was never aware of any extra pain caused from the thora. I also never had any lung problems associated with it.

I'm extremely happy that I had the thoracoplasty, and I know some others who are pleased with theirs also. My back looks pretty normal now. I used to buy clothes a size too large in a vain attempt to hide the rib hump. Yesterday I was trying on a spaghetti-strap top when I glanced at my back in the mirror. My eyes welled up with tears at how good it looked! It fit perfectly straight across, just under my shoulder blades. No longer was one side of the top a few inches higher than the other, or sticking out more than the other.

It's been 16 months since my surgery, and I'm still amazed at how my body has changed for the better in many ways. And for me, having the thoracoplasty helped produce part of that change.

Anne

ShariMSU
05-24-2010, 06:25 PM
My rib hump appears to be minimized to almost nothing with surgery. I did not have thorac....
I can't bend over yet to see if it bumps up, but it appears to be much better and my shoulder blade "wing" is very minimized.

golfnut
05-24-2010, 09:33 PM
I have heard nothing but praise for Dr. Lenke and will not change surgeons, but hope that if he doesn't think the derotation will take care of the rib hump that he will consider doing a thoracoplasty. I guess I'll find out at the pre-op. I sure wouldn't want to go back at a later date for a thoracoplasty with another surgeon if the rib hump was still visible. I guess I'd just live with it. No matter what our age is, I think most of us want good cosmetic results as well as a good prognosis for later years.

Doodles
05-24-2010, 09:47 PM
Anne--Thank you for that information. You must have had a great result.

Karen--I'll be anxious to hear what you find out from Dr. Lenke. I feel so stupid I didn't know about this part until afterwards. I thought I'd done so much research. It never came up for me. I just assumed the surgery would fix it. Yes, it made it much better but... Janet

JenniferG
05-25-2010, 04:26 PM
I'm another one who didn't have thoracoplasty but my rib hump has gone. I left it to my surgeon to decide whether I needed the thoracoplasty on the day. Like some others here, I disliked my rib hump more than the curve.

golfnut
05-25-2010, 04:43 PM
Jennifer,
That's encouraging to hear that you and others had a reduced rib hump without a thoracoplasty. I will also be fused T4-Sacrum, so that gives me hope.

MarlenePowers
06-02-2010, 12:02 PM
I had a thoracoplasty done in conjunction with my fusion from T2-T12. Dr. West removed just the rear portions of 3 ribs to reduce the hump and use with the graft. I went from 50.11 to less than 10. I can say this, my ribs hurt more on the side that I have all of them(from the de-rotation), than the side the thoracoplasty was performed on. I was 40 when I had my surgery. I believe that the younger and more flexible your spine is the better result of rib hump reduction with de-rotation and fusion alone. ;)

kennedy
07-17-2010, 04:12 AM
I agree with Laurie on this about the Thoracoplasty me and her has the same spine surgeon. it also the experience that the surgeon has with that surgery. I didn't want to be at my gradaution from high school with the rib humb. my parents didn't no that Dr Gupta was going to do a Thoracoplasty to reduce the rib hump. I glad i went to my high school gradaution