Thoracoplasty

[Cheryl M]

Just wanted to know if you've had thoracoplasty to reduce a rib hump, what the results were and if it was a painful recovery. Trying to decide for my daughter. Thanks! Cheryl

[Carmell]

Hi Cheryl,

Good post. I'm looking for information for my son too. He's 10yrs old and we've asked our ortho about a thoracoplasty. Ortho didn't give me a time-frame that would be best for my son.

The few things I do know (partly from our few surgical experiences, and partly from others) is that bone surgery is often a painful surgery. Cutting out ribs and re-aligning the shape of the chest, and then recovering is painful. Ribs are painful because they can't be completely immobilized - you always need to breathe. I'm hoping that it isn't as big and bad as my imagination is making it out to be.

I'll be anxious to read replies.

[jc3]

hi cheryl and carmell
my daughter is 15 and had surgery last november and along with her surgery had a thoracoplasty. Now almost a year post op (I cant believe it's almost a year!!) she is doing great. Most people say that they are in pain after having the ribs removed, but my daughter did have any complaints about that area hurting more. The dr. had even said after her surgery at about the 2 week mark post op there may be pain in that area and there never was. I'm so glad that we did it because her rib hump looked really bad. I wouldn't say it is not 100% better, but i'd say 90-95% better looking. When the ribs grew back that one does stick out a little bit more then the other and when she bends over you can see it, but it is not at all like it was. I look at it this way, they have to take bone from somewhere for the bone grafting and have heard that when they take bone from the hip that hurts after as well and if the rib hump is bad then it should be done.
any other questions feel free to ask
Good luck
Jennifer

[LilSkittlehunni]

hey! this is cheryl m's daughter. thanx so so much for the advice and input on thoroclaplasty!(sp?). me and my parents are tipsy on what we should do.... i know that everything will turn out for the better though. thanx again!

[Carmell]

Hi Jennifer!

I can't believe its been almost a year since her surgery. Time flies! I'm so happy to hear she is doing well and that the thoracoplasty part of her surgery was not a major problem in her recovery. I hope everything continues to go smoothly for her, and you!

Take care!

[jc3]

thanks carmell
i couldn't imagine a year ago this time being on this end. The anticipation of the "unknown" before the surgery was the hardest part. I am thankful that she is doing so well also.
Jennifer

[ScolioGirl]

My doctor told me that since they use screws, not hooks on the vertebrae now (lovely to think about that hardware, isn't it? ) they can also unrotate the vertebrae quite a bit and a thoracoplasty often isn't necessary.

[ProudParents]

From our readings, the stronger fixation of the pedicle screws allow for greater derotation of the spine and thoracoplasty only gives a slight additional improvement of the rib hump. Abstract 7 on the following link discusses this although it refers to modern instrumentation and doesn't specifically mention pedicle screws:

http://www.srs.org/meetings/am04/abstracts.pdf

Of the surgeons whom we have spoken with that primarily use all pedicle screws, some perform thoracoplasty and others don't. Of those who do perform the procedure, their primary reason is to obtain an ample supply of autogenous bone and the secondary benefit is cosmetic. Surgeons who prefer to use either allograft or bone from the hip didn't believe thoracoplasty was necessary.

In other studies, thoracoplasty has been linked to an increase in proximal junctional kyphosis after surgery, although the studies didn't really explain why.

Our daughter's surgeon intends to use all pedicle screws and will be taking just enough bone from the rib to use as autograft.

[Cheryl M]

Thanks

Thanks to all who have replied. My daughter is a patient at Shriners, Greenville, SC. I'm not sure if they use the pedicle screws or not but from what I've read, the screws help improve the rib hump quite a bit. I plan to call Shriners, but has anyone had surgery in Greenville and know what the Dr.'s there use.

I talked with her Dr. on the phone and he felt he would get good correction of the rib hump from the posterior surgery but he has not ruled out doing thoracaplasty for bone and cosmetics.

Cheryl

[KRIS ATKINSON]

I have talked to some people on the phone who use this forum and some who don't feel comfortable with it recently. These conversations have included private messaging on NSF also. I will share what I told some and what I found out from my daughter personally yesterday. My daughter doesn't notice any pain difference between the thoracoplasty part of her surgery and the spinal part, at 2 months post-op. She gets sore by the end of the day, but it is apparently not related primarily to the thoracoplasty. If I had the choice to do the thoracoplasty again vs just the posterior and anterior, I would. I noticed this morning during her daily shower, that it was really hard for me to notice a rib hump on the site where surgery removed parts of ribs, but I remember feeling really sad for her a week prior to surgery when I saw her huge hump at that point. I am comparing thoracoplasty and 75 degree curvature which required posterior, anterior, chest tube, etc, to doing to surgery without thoracoplasty but still having the posterior, anterior, chest tube, etc. In our situation, the choice was minor compared to all the other parts of surgery, I feel. Those of you who may have less severe humps or smaller curvatures when it comes time for final measurements may have different opinions regarding thoracoplasty. I feel it would not have straightened out enough on its own, after straightening the curve, if the doctor had not removed some ribs. As I said, she had probably the most major surgery possible for scoliosis, no transfusion needed, no hip graft. She is also quite athletic but small boned, so her muscles were ready to get up and walk all over as soon as they allowed her to at the hospital. Good luck for all those making decisions regarding thoracoplasty. Ask more if you want. Kris

[LilSkittlehunni]

Thanks Kris, that's pretty much what my daughter's DR. told us about the pain. I'm still waiting on a call back from Shriners about the Hooks vs. Screws. I'm hoping they use the pedicle screws, given all that I've read, they seem to be more effective in reducing the rotation and the rib hump.
Have a good weekend! Just realized this went under my daughter's name. She must have already been signed on. She has found this forum to be extremely helpful and it has really opened her up to asking lots of questions.
Cheryl