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mixasu
11-08-2009, 09:42 PM
Another surgery question my family and I have been discussing:

Does your rib hump go away after the surgery? If not, does it dramatically improve? I specifically asked my doctor if he is going to touch my ribs and he says that he does not. I was kind of relieved b/c I heard that the removal of ribs is extremely painful!!

kt2009
11-08-2009, 09:51 PM
I was just lamenting today that I wish I had better cosmetic effects from my surgery...but that's not why I did it, so I'm okay with that! I did not have a very long fusion...the doc just worked on the worse part of me. The rib hump in my lumbar region has gone away, but I still have it a little above my fusion. I think it depends on the type of fusion, what shape you are in as far as arthritis, degeneration, etc. and I'm sure a lot of people here can answer this better than myself.

As for the rib removal, my side incision and where my rib was removed was what bothered me most in my recovery. But PT has helped a lot with stretching and movement. The rib hump has less to do with rib removal than how much your spine has rotated...I think...anyone else out there help me with this...

LindaRacine
11-08-2009, 09:56 PM
Hi...

I've seen a huge difference between patients in terms of how much reduction they get. If it's important to you, I'd recommend that you ask for some references from your surgeon, and talk to those references about their rib hump reduction.

Regards,
Linda

JenniferG
11-08-2009, 11:39 PM
I didn't have any ribs removed but my rib hump has gone. There is the very slightest rise in the spot where it was, but it isn't visible and I can barely feel it. I would think Kathy's correct, it's more to do with the rotation.

briarrose
11-09-2009, 05:21 AM
My rib hump is completely gone. My surgeon said he would be able to reduce it some, so it was a big surprise when I realized it wasn't there. It was pretty large before my surgery. I did not have a thoracoplasty.

Shell

Jimbo
11-09-2009, 05:35 AM
My surgeon told me he would determine if a costoplasty is required during surgery. I informed him I wanted it gone and he seemed quite happy to help me with that :)

I just know that if I went through this massive operation and recovery and did not get any reduction in the rib hump I would be quite :mad:

If I were you I would really bring this up with your surgeon! You can always get a costoplasty later in life if you wish, but that means going under the blade again.

pmsmom
11-09-2009, 05:47 AM
My dd still has a small hump. Her scoliosis was at 60 degrees and the surgeon corrected it to the mid-20s. She was starting to rotate some as well.

Her ribs are now even and you can tell that from the front.

We weren't concerned about the cosmetics so much as the impact on her health if we didn't get the surgery done.

titaniumed
11-09-2009, 09:53 AM
My rib hump is completely gone and still have quite a bit of rotation. It shows how much the ribs alter their shape growing up with scoli.

My rotational Ct scans are in this thread. Notice screws. Cts are looking feet to head. I'm still about 30 degrees off above and below apex after surgery.

http://www.scoliosis.org/forum/showthread.php?t=8622

When the Docs adjust the rotation of the vertebrae, the ribs move with that adjustment. The SSEPs determine how far they adjust.

http://www.spine-health.com/conditions/back-pain/somatosensory-evoked-potentials-ssep

Overcorrection is not a good thing. Coming out pain free is the goal with scoli surgery.
Ed

sillycoffeegirl
11-13-2009, 05:22 PM
my first opinion doc said he would not take the ribs out cuz it causes lung problems later. But if he doesnt will i still get rib hump reduction? :confused: And he didnt do any bending xrays like i thought he would only did a stretch out one were he pulled me. But i dont think that is that accurate. I hope i get some rib hump reduction, i want to look pretty if i have to be more stiff. :rolleyes:

kt2009
11-13-2009, 08:20 PM
You don't need rib removal to reduce the rib hump. My rib was removed in order to get to the spine and then used for my fusion. As the spine is corrected with the instrumentation, it will rotate back to close to where it should be...I believe that his is how the rib hump is reduced...correct me if I'm wrong out there!

tonibunny
11-13-2009, 09:00 PM
Quite often, the rib hump reduces considerably during the spinal fusion operation, because the vertebra are derotated and the vertebrae get pulled back into place as this happens.

However, sometimes the rib hump remains to some extent, especially if it has been there for a long time and the ribs have themselves grown deformed. In this case, a procedure called a "costoplasty" (also known as a "thoracoplasty") can be done, which involves removing sections of rib at the apex of the hump in order to flatten it. This procedure can be done at the same time as a spinal fusion surgery, or it can be done later on as a separate operation.

Years ago the old types of rods (ie Harrington Rods, that are no longer used) did not derotate the spine, and so quite a few people with older fusions may still have a significant rib hump. In cases like this, the amount that the rib hump can be reduced is dependent on how much the spine continues to rotate out into the hump.

I've had a costoplasty done twice and the results are really dramatic. I had it done first during a spinal fusion surgery, but afterwards it bcame apparent that they could get a lot more correction and so I had a second costoplasty done as a standalone procedure. The results are amazing. I had a really prominent hump due to having had infantile scoliosis and a massive amount of rotation - 29 degrees on the scoliometer, which only goes up to 30 degrees! (nb degree of rotation is not the same as Cobb angle) Even though my spine still rotates into my hump, it's barely noticeable now. The surgery is very very painful, but in my opinion it is well worth it :)

kt2009
11-13-2009, 10:32 PM
That was a great explanation...cleared a few things up for me! Thanks!

Shari
11-13-2009, 11:01 PM
Hi There,

I had a rib and some hip bone removed. My Doc. asked me if I would like it reduced and of course I said yes. If I was going to go through these surgeries, I wanted the best results I could get. As far as the rib pain, never noticed it from all the other pains.

I have no rib hump, don't have to hide my back anymore. But if someone bumps that rib knob or my hip when the bone was removed, it hurts like hell.

I find myself avoiding crowds, which is odd for me, because I was a restuaranut manager my entire a adult life.

Shari

titaniumed
11-13-2009, 11:03 PM
Tonibunny

I agree, the Harrington rod system did about the same thing that a bumper jack would accomplish. Its not a system to brag about, that's for sure. It was the only thing they had back then, and it was used out of desperation. I believe the Luque wire came on the scene right around 1975.

I wonder why Dr Harrington discounted the use of screws back then. I wonder if they had flouroscopy in 1960?

I also had and still have a large amount of rotation, but no rib hump.If I would have continued my surgery in 1975, my rib hump correction would have been minimal. The luque wire system was a better alternative back then, at least they could grip and hold each vertebrae to a certain extent.

Those poor surgeons back in the old days really didn't have much to work with. I feel sorry for them, they did the best they could. I'm sure that it drove them crazy.

================================================== ===============================

Anyone concerned about rib humps with today's hardware systems stands a much better chance of correction due to the fact that the surgeons have much better control with pedicle screws. The hardware systems they use today are engineered to the hilt. The amount of engineering time that's been used to develop this stuff is phenomenal.

As far as stiffness goes with fusing the thoracic area, There really isn't much difference at all since you don't bend much in that area. You do lose your ability to twist.

Ed

loves to skate
11-14-2009, 12:55 PM
[QUOTE=titaniumed; I wonder if they had fluoroscopy in 1960?

Ed[/QUOTE]

Yes Ed, I can remember fluoroscopy back in the 1940's. My brother was in the hospital with corn in his lung back in 1946 and I remember seeing him behind the fluoroscope. I was only 5 at the time and when my brother wanted to see me behind the fluoroscope, I started crying and refused. There used to be fluoroscopes in shoe stores and as kids, we loved to see the bones in our feet and wiggle our toes. Eventually, they were removed from the shoe stores (the fluoroscopes, not us kids) because of the danger of radiation. I don't think the fluoroscopes of today emit as much radiation as those in the 1940's. I don't know when they were actually invented though.

Sally

mixasu
11-15-2009, 09:28 AM
Thanks everyone for your responses!

What do you mean you lose your ability to twist? When you drive, are you still able to twist to see who's next to you? Are you still able to dance?

tonibunny
11-15-2009, 09:47 AM
You don't have much ability to twist in the thoracic area anyway, so please don't worry. You mainly twist from the lumbar area. I'm fused T1-L4 (so I have just one vertebra that can move, at the bottom of my spine) but I can still twist round enough to drive :) And I can certainly dance, I spent my 20s out clubbing every weekend :D

mgs
11-16-2009, 08:11 PM
My rib hump is considerably less than pre-op. I'm thrilled!

But. . .maybe I'm hallucinating. . .but I think it's more pronounced than it was a couple weeks ago. Could this be? (I have noticed, in this past week or so, that there is a feeling of tugging just to the right of the apex of my thoracic curve.)

Doodles
11-16-2009, 09:15 PM
MGS--
I'm with you on that one. I think my rib hump is worse than in the beginning too. Part of it could be the first few months we're so out of it with pain, brain fog from meds, and just happy that it looks so much better than before that we tend not to notice. Part could be the swelling going down too. In fact this whole thread is making me think I'm the only one still with a rib hump and somehow I never really talked thoracoplasty with him and he thought the straightening would help with that and rotation. It's certainly better overall but I've got this leaning thing and also as time has gone on I noticed the rotation too--it's like my navel is off kilter an inch or so. I'm actually writing a list of ?'s for his nurse now but think this is not going to get better or have anything that can change it. I hope it doesn't get worse. Janet

kt2009
11-16-2009, 10:23 PM
Ok... I'm with both of you. Initially i thought my rib hump and my hip-sticking out looked great. Now I'm thinking not so much. But I also continued to lose weight after my first look in the mirror and I think maybe it looks so pronounced cuz I'm a little bony. But I have to keep thinking it's better than it was...that much is obvious. My stomach looks slimmer b/c I'm not so scrunched!
Sometimes I think I look great and other times I'm disappointed...though my doctor was very up front about not being able to completely correct me prior to surgery. And he and the other surgeons (and actually my PT) were extremely happy with the results. SO I think I have to move on....

Doodles
11-17-2009, 03:10 PM
Kathy--
I guess it is comforting in a way to know there are a few of us that feel this way. I know you're right about needing to move on. We want to rejoice and we are happy for all the super successes; it's just sometimes I feel like mine didn't quite get to where the others are. It's hard to even talk about since one doesn't want to seem ungrateful, I guess. As long as it's not going to get worse I can deal with this. Thanks for your response! Janet

dolores a
11-17-2009, 05:20 PM
When everyone is speaking about rib hump, are you all speaking about the back ribs or the front? Before my surgery, I asked the surgeon about my ribs that jutted out on my left side in front if this would be corrected, he told me not 100%, but it would not look as pronounced. That is exactly what I got, it's still there, just not as obvious. Before the surgery, I could put me hand under the ribs they stuck out so much. But like most of you say, I am still so happy with my results in the pain and cosmetic department.

Doodles
11-17-2009, 10:16 PM
I know what you're talking about on the front, Delores, and mine is better there too but certainly off with my leaning. The rib hump I'm referring to is on the back--a milder version of the "humpback" look I had before. My big curve was on that right side. It is actually less bothersome to me than the lean to the left. I apologize if it sounds like a whiney day here. Janet

nervous
11-20-2009, 08:58 PM
I still have a rib hump on the right upper side. It is very frustrating and matter of fact I was out trying on clothes earlier tonight and still don't like the way I look in shirts (from the right side).

It's almost like my right shoulder blade doesn't lay right. I would've thought after the surgery it would not be so pronounced. :( I just hate the idea of going back under the knife as I am finally starting to "feel like myself again". No meds, and pretty good movement!

jrnyc
11-20-2009, 10:14 PM
Hi everyone
i didnt know what a costoplasty was, so i googled it...anyway, after i read what it is, i looked at some of the other entries...

if you look at the entry from The Journal of Bone & Joint Surgery, there is a study under BoneSpine...that talks about corrections of rib humps with the costoplasty procedure...mentions something like (i dont remember exact numbers, trying to give an example) 30 correction right after surgery, 25 correction six months later, something along those lines...also concludes that the procedure corrects the rib hump as much as can be, & further surgery does not increase the correction...if i remember correctly...it discussed effects of the surgery on lung function also...

anyway, would suggest just googling "costoplasty" & checking out the results with the listings of research studies...


good night all
jess

joyfull
11-20-2009, 11:16 PM
I have been reading all these posts with interest. I am scheduled for surgery for the first time on June 23rd with Dr. Boachie in New York. I hope to go back to work in Sept. (I am a teacher.) I went to Clear Institute in Minnesota in 2007 and since then my spine and rotated more and the hump is more pronounced.

I have a 90 degree curve and this will be my first surgery. Dr. Boachie at first suggested anterior/posterior surgery, but now he is talking about posterior only, that he can get the curve down to 55-60 degrees. He spoke about the rib humb surgery.

I am afraid of reduced lung function. Is this a result of the corrected rib hump? Does anyone know anything about Dr. Anand in California? He says that may be able to correct scoliosis with a minimally invasive procedure that will cause much less blood loss and an easier recovery. Thanks for your responses. Joy

RitaR
11-21-2009, 07:57 PM
If I get to hear a song as I go into surgery in July it's going to be one about miracles! Love the song. Thanks for putting it on your post.

mixasu
11-22-2009, 09:20 PM
Are you speaking of Time For Miracles that I posted on my blog? If so, it's a beautiful song! The first time I heard it I almost cried. It reminded of Titanic, almost a bittersweet kind of song. Agreed - The last song I want to hear before surgery is definitely that song because it gives a sense of hope. Good luck with your surgery. :)

tonibunny - I am glad that you can dance! It's one of my favorite things to do. I would be crushed if I couldn't.

As far as the rib hump goes, I would hate to undergo the whole surgery and not get rid of it. I am not in any pain right now, although I have been warned that I will be in serious pain in a couple of years. The surgeon said that the surgery was inevitable and that it would be easier to recover at a younger age. The recovery advantage and the rib hump were the two main factors in my decision.

nervous
11-29-2009, 06:40 AM
Don't count on a rib hump correction as I didn't have any ribs removed and still have a hump. I try to hide it with a larger size top; however, it's still there even after surgery. I was hoping to get rid of mine too. :(

However, with Tylenol a couple times a day, I have much LESS pain since surgery!!

sccrm08
11-29-2009, 09:59 PM
My Dr. was able to reduce the rib hump to where it is not even noticible and I did not have any ribs removed. He said it was the derotation and straighting that did it.

kristis
11-30-2009, 07:23 PM
I had a thoracoplasty with my correction. Initially, it was the most painful area. I did not have a second incision Dr. Jeong was able to do the procedure with the rotation correction. Now, at 3 months post op I don't have any rib pain but noticed my rib pops when I over do it during breathing. His PA during a phone consult said it could be from inflammation. I am now on 5mg. hydrocodone I take about 3 times a day. I am awake at night uncomfortable. But, I can now take a deep breath and it does not burn and I actually get a breath. Something that was not possible pre-op. I see Dr. Jeong tomorrow and will ask. I also can't stand up straight yet but that is another question.:o
Kristi
preop Thoracic curve 75,lumbar 70
post fusion with thoracoplasty
excellent correction.