PDA

View Full Version : ribs shape evolution after spinal surgery



richardis
09-07-2016, 08:51 PM
I am wondering what happens to the ribs after scoliosis surgery is done. The concave side of my scoliosis prior to scoliosis surgery has crushed ribs to an extent. On the convex side ribs widen up. The thing is:
What now?

Pooka1
09-07-2016, 10:39 PM
I am wondering what happens to the ribs after scoliosis surgery is done. The concave side of my scoliosis prior to scoliosis surgery has crushed ribs to an extent. On the convex side ribs widen up. The thing is:
What now?

Well, depending on how much you were corrected, it may not be possible to see any deformity of the ribs. I see no rib deformity on my girls for example.

richardis
09-07-2016, 11:13 PM
It depends, your girls had surgery at a younger age, I suppose. So the ribs were not that crushed.

I say this, because sometimes surgeons and patients alike assess the success of the op looking only at how straight is the spine . But if we have a look at the ribs on the x ray we have a much broader assessment of how the surgery went.
I assume that rib deformity is linked directly to the rotation and cobb angle of the spine prior to surgery.

Now that surgery is done, ribs may be affected by the new biomechanics of the body, and I hypothesize that the widened ribs may change shape due to the effects of gravity. The pull of gravity will even out ribs on both sides of the rib cage. Ok, this is my wishful thinking as Wolff's law contradicts all that I have said before.

If a thoracoplasty is made it takes place on the crushed ribs on the concave side, doesn't it?

Side note: ribs affect shoulder resting position

What do you think?

jackieg412
09-07-2016, 11:46 PM
You will be able to see the ribs better on a 3d Ct scan .

LindaRacine
09-08-2016, 09:35 PM
You will be able to see the ribs better on a 3d Ct scan .

It doesn't have to be 3D to see deformity. You can see an image here:

https://openi.nlm.nih.gov/imgs/512/27/3532837/PMC3532837_1471-2474-13-259-1.png

I'm pretty sure that the ribs don't change their overall shape from spinal fusion surgery. The whole ribcage is rotated so the visible deformity can disappear, but the rib deformity is still there and can sometimes be seen from the front.

--Linda

richardis
09-09-2016, 12:01 AM
It doesn't have to be 3D to see deformity. You can see an image here:

https://openi.nlm.nih.gov/imgs/512/27/3532837/PMC3532837_1471-2474-13-259-1.png

I'm pretty sure that the ribs don't change their overall shape from spinal fusion surgery. The whole ribcage is rotated so the visible deformity can disappear, but the rib deformity is still there and can sometimes be seen from the front.

--Linda

I am afraid that both of you are correct. It has not to be 3D but it has to be a CT Scan. The image Linda Racine posted comes from this article and it is a cross-section of a ctscan:
https://www.researchgate.net/publication/233972821_Vitamin_D_Receptor_gene_VDR_transcripts_ in_bone_cartilage_muscles_and_blood_and_microarray _analysis_of_vitamin_D_responsive_genes_expression _in_paravertebral_muscles_of_Juvenile_and_Adolesce nt_Idiopat


I would like to leave here some inspiring advancements in this field:
http://www.forbes.com/sites/amitchowdhry/2015/09/19/how-surgeons-implanted-3d-printed-titanium-ribs-in-a-cancer-patient/#7e02fbba9a09

Some extra notes:
-ribs expand as we breath in
-some surgeons can reduce rib hump in surgery, so ribs may change orientation (not sure if shape) on the procedure

As we know, as we get older if scoliosis does not get treated ribs will get crushed even more (I assume this is related/linked to the progression of the spinal curve)

Linda, on your follow-ups of patients who underwent surgery did you notice any change on the ribs shape as time advances ( we (patients) tend to focus on the spine only), what is your experience?

richardis
09-09-2016, 12:19 AM
http://d3rzbccgedqypw.cloudfront.net/content/jbjsam/85/3/399/F11.large.jpg

This image may enlighten our discussion further.
Again, this is more difficult to tackle and comprehend than we can imagine.

LindaRacine
09-09-2016, 10:39 PM
Linda, on your follow-ups of patients who underwent surgery did you notice any change on the ribs shape as time advances ( we (patients) tend to focus on the spine only), what is your experience?
No. I have seen posts from patients over the years, who felt that there rib humps got at least slightly more prominent over time. I think it may depend on something like the type of implants used or how the spine is derotated during surgery. Also, most of our patients are older adults, who probably aren't as focused on their rib hump.

--Linda

richardis
09-25-2016, 11:26 AM
No. I have seen posts from patients over the years, who felt that there rib humps got at least slightly more prominent over time. I think it may depend on something like the type of implants used or how the spine is derotated during surgery. Also, most of our patients are older adults, who probably aren't as focused on their rib hump.

--Linda

Apart from the rib hump, do ribs even out?
In here http://www.srs.org/images/patients-families/conditions-and-treatments/posterior_approach.jpg you can see that the ribs on the right (after surgery) go in a downward fashion coming from the spine. The left side assumes a more normal shape of ribs.

This is an x-ray with the correct shape of the ribs.
http://images.radiopaedia.org/images/8691587/25ad79e3dfb3f9fe158277b9ae2d0a_jumbo.jpg

My question is: should we expect that the ribs of the left side (after surgery) will even out or should we expect further smashing of the ribs on the right side ( the side of the rib hump) to go in a downward fashion even more?

Do ribs are supposed to wear and tear over time?

This question is not only to Linda, but to all of you if you think you can contribute.

Pooka1
09-25-2016, 12:03 PM
I am spitting in the wind here because I have no credentials but I suspect that if you maintain your hyper-correction (I don't think you technically have scoliosis any more), your ribs won't move from where they are now.

You do seem to have some small residual rotation based on screw visualization but your rods are almost completely super-imposed on sagittal view so I am guessing it is not noticeable to people who don't to look for it.

I have never looked at my daughters ribs on any radiograph but rather focused exclusively on the amount of correction they got in the spine so I can't say what their ribs are doing. The key is evening out the load on the lower discs and I think the ribs just come along for the ride. You appear to be like my one daughter who can credibly hope for "one and done" surgery due to hyper-correction. Of course you would need to ask your surgeon about that. I am just spitting in the wind here. :-)

LindaRacine
09-25-2016, 12:03 PM
The ribs will not resume a normal shape. Their positioning, however, can change significantly. The new positioning will make them look like they're more normal from the outside, but if you had an axial image taken, the ribs would look deformed.

titaniumed
09-25-2016, 02:00 PM
if you had an axial image taken, the ribs would look deformed.

Here is an example...

Attached below is a slice of my CT scan (taken 15 months after my scoliosis surgery)

Notice my rib shape. The ribs do get rotated around along with the spine in the rotational correction process that happens with the modern hardware systems of today.

I still have a small rib hump, but itís a huge improvement....My rib and spine shape is now permanent, its my final shape.

This started as a 70 degree thoracic curve.

Ed

richardis
09-28-2016, 10:19 AM
can ribcage movement while breathing reshape ribs after surgery? https://www.youtube.com/watch?v=_Ph9tlaUSfo

what about the rib hump before surgery? Is it the curve (solely) that determines the rib hump or the weight of the scapula over the rib cage has its role as well? What do you guys think?

Pooka1
09-28-2016, 10:56 AM
can ribcage movement while breathing reshape ribs after surgery? https://www.youtube.com/watch?v=_Ph9tlaUSfo

Yes in a person who has not had surgery but not sure that matters. Martha Hawes published radiographic proof she increased the distance between her spine and sternum from breathing. This, in my opinion, is what drove her curve reduction.


what about the rib hump before surgery? Is it the curve (solely) that determines the rib hump or the weight of the scapula over the rib cage has its role as well? What do you guys think?

My understanding is the rib hump is caused by the rotation which drives the curve. I don't think the weight of the scapula can possibly affect anything about the rotation/curve.

jackieg412
09-29-2016, 01:19 PM
I won't think the weight of the scapula has anything to do with it. In all actuality it isn't very big. My upper extremity specialist and I had this discussion when he removed about 25 percent of mine. The scapula kind of floats and is attached by muscle only. It may be affected by rib placement but doesn't affect the rib shape.