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  • Newbie, Surgery on May 20th, Thoracoplasty Question

    This is my very first post. However, I already feel like I have a group of friends who will be very important people in my life. I especially appreciate Karen and Linda and Pam who have helped so many people on the forum. My biggest fear has been that I'll post a question and nobody will reply. Well, I suppose we have to face our dragons!

    Here’s my abbreviated history: I had a 59* “C” curve at age 14 and Dr. Tom Brown at Stanford Hospital fused from L4 to T1 without instrumentation - 1966. I was in a plaster body cast for a year post-op. My curve was reduced to 29*. I simply forgot that I ever had a problem and did absolutely everything – down-hill skiing, technical rock climbing, backpacking. No limits.

    In my late forties, I started getting back pain. My curve had progressed to 42*. I finally quit my work as a child care provider at age 50, because of back pain and my Alzheimer’s mom needing help. I began doing yoga and Pilates on a daily basis. My pain decreased as I gained strong abs and more flexibility. However, the curves continued to get worse and the pain gradually returned. Now, at age 55, I have a 60* curve.

    Since there are no adult scoliosis specialist in Utah (my home state) I selected Dr. Boachie in New York . . . even before finding the forum and reading other people's experience with him. Surgery has been set for May 20th. The written surgical plan includes a thoracoplasty, something we didn't discuss during my initial appointment. I found the forum and discovered that it was a cosmetic procedure. I called Dr. Boachie's nurse and told her that I am perfectly happy with my rib hump and would prefer to avoid the thoracoplasty. She said it was a necessary procedure, because it would create more room for my lungs as well as providing bone graft material.

    I have read over 70 posts on thoracoplasty and I am still confused. Some forum members talk about thoracoplasty as being the REMOVAL of ribs, sometimes as many as five or six ribs. Others seem to indicate that they had a segment of certain ribs removed. Does a thoracoplasty mean either the removal of the entire rib or a part of the rib? If an entire rib is taken, can it truly grow back?

    I also wonder about the risks of a thoracoplasty. One post indicated that the chest cavity is smaller after this procedure. That runs counter to the idea of creating more room for my lungs, as explained by the nurse. A few people say that there will be lung complications down the road. If there has been any research conducted on thoracoplasty, I would appreciate learning anything you know about this procedure.

    Thank you!
    Ginger
    Ginger Woolley

    Oct 2018, L3 - S1, Anterior & Posterior, Dr Sigurd Berven, UCSF, San Francisco
    ******
    May 2008, T4 - L3, Dr. Ohenaba Boachie, Hospital for Special Surgery, NYC
    ******
    Sept 1967, T4 - T 11, without instrumentation, Dr Thomas Brown, Stanford

  • #2
    Welcome, Ginger.

    Yes, Dr. Boachie likes to use rib material for his bone grafts. I'm embarrassed to say I'm not sure whether he took a whole rib or just part of a rib from me, but he did eliminate my rib hump entirely. Before the operation, I didn't think I cared about my rib hump either, but I have to say I'm really happy not to have it anymore. In terms of cosmetic results, I think Dr. B is a real artist.

    Since I had a large thorocolumbar curve, my anterior incision is about 20" long and runs from my hip bone to my shoulder blade. It still feels tender and crampy. I was told that my curve would eventually impact my diaphragm, and now that I'm straightened out I don't have to worry about that anymore. However, since my diaphragm muscles were cut and my lung nudged around, I did lose some pulmonary function, but it was only noticable when I tried to start singing again at around 6 months post-op. I've worked like a dog with breathing exercises, etc. and now I have about 80 percent of my lung capacity back. I'm told that the compromised function was temporary and could last up to 2 years but I expect to be fully functional again by the summer.
    Chris
    A/P fusion on June 19, 2007 at age 52; T10-L5
    Pre-op thoracolumbar curve: 70 degrees
    Post-op curve: 12 degrees
    Dr. Boachie-adjei, HSS, New York

    Comment


    • #3
      Hello Ginger,

      I have an 80º thoracolumbar curve and have consulted with four excellent surgeons, none of whom told me that I would require a thoracoplasty. I am really surprised that this was not discussed with you during your initial consultation with Dr. Boachie as this is a major invasive procedure. I would definitely advise you to discuss your concerns with Dr. Boachie himself before proceeding with something with which you do not feel comfortable.

      Good luck.

      Chris

      Comment


      • #4
        Welcome!

        Hi Ginger! I'm so glad you are part of the forum! I can't help you much with the thoracoplasty question, as I didn't have one. But it is described in both books that I have about scoliosis/scoli surgery, and if you don't have either of these books, you might want to check into getting one or both. They are Scoliosis Surgery: The Definitive Patient's Reference by David K. Wolpert (my favorite book) and The Scoliosis Sourcebook by Michael Neuwirth, M.D., and Kevin Osborn. Both books are very informative. The Wolpert book has a narrower focus-- on the surgery and all that surrounds it, and is written from a patient's perspective. It is very easy to read and quite informative about scoliosis, the different approaches to surgery, recovery, getting your home ready, etc. The Neuwirth book is written from a scoliosis specialist's perspective, addresses the condition and all avenues of treatment. It is still fairly easy to understand, and has several case studies from patients of his. The thing to keep in mind with either book is that we are all different, our surgeons are all different, and so it's not a one-size-fits-all surgery and recovery... I found I was comparing myself to the people in the books and feeling a little disappointed with how long some things took me.

        Also wanted to let you know we have a thread going in the "surgical-(first time)" area with April, May, June surgeries. I put your name down, but if you give me more info I will add that too. Also, if you read post #11 in that thread, it tells you how to post your surgery on the official surgery calendar. If you have any questions send me a PM-- or just post.

        Again, welcome to the forum. You've come to a great place for information and support. We're all in this together!
        71 and plugging along... but having some problems
        2007 52° w/ severe lumbar stenosis & L2L3 lateral listhesis (side shift)
        5/4/07 posterior fusion T2-L4 w/ laminectomies and osteotomies @L2L3, L3L4
        Dr. Kim Hammerberg, Rush Univ. Medical Center in Chicago

        Corrected to 15°
        CMT (type 2) DX in 2014, progressing
        10/2018 x-rays - spondylolisthesis at L4/L5 - Dr. DeWald is monitoring

        Click to view my pics: pics of scoli x-rays digital x-rays, and pics of me

        Comment


        • #5
          Hi, Ginger! I just had a revision w/Dr. Shelokov in Plano, Texas on April 8th that involved the removal of 2 ribs on the right side in order to reduce my rib hump. Of course it's too soon to tell whether or not I will be pleased later on, but right now I am happy with the way my back looks and feels, once those chest tubes came out. Can Dr. Boachie show you before and after pics of patients who've had both procedures? AS well as before and after estimates of pulmonary function?

          Anyway, just wanted to say "welcome" and best of luck whatever you decide. You will get good, no-nonsense advice around this place.
          Posterior fusion T5-L1 May 5, 2003-age 43
          Posterior revision, thoracotomy,fusion T2-L2 April 8, 2008-age 49
          Fusion extension C1-L2 evacuation left pulmonary effusion May 9, 2008, age 49
          www.buggfamily.blogspot.com

          Comment


          • #6
            Hi Ginger!

            We're having surgery the same day! I had asked my surgeon about doing a thoracoplasty to get rid of my large rib hump. He said he would be willing to do it, but did not recommend it. He said it can cause long term lung impairment. Since I have asthma, I decided it's out of the question. It sounds like Dr. Boachie does them all the time. I've heard such good things about him so be confident that you are in good hands. If you aren't comfortable with the thoracoplasty, I would discuss it with him.

            Good luck!

            Shell
            Chemist, 30

            1998- 18 degrees
            2003- 33 degrees
            2005- 37 degrees
            2006- 44 degrees
            May 2007- 47 degrees
            December 2007 - 50 degrees X-ray

            Surgery May 27, 2008
            Fused T1 to L2
            Curve corrected to 15 degrees X-ray

            Comment


            • #7
              Many MANY Thanks!

              Dear Singing Chris, Chris WBS, Susie Bee, Tricia and Shell,

              Thank you so so much for responding to my question. WOW! I now feel brave enough to throw out a second question, which I'll do on a new post.

              I have ordered David Wolpert's book and plan to get a little better informed before I approach Dr. Boachie about my concerns. I would love to get more information on the subject of what's actually involved in removing a rib or two or more! Also, I'd love to hear of any other risks associated with the procedure.

              So I excited about sharing my surgery date with Shell (Briar Rose).
              Ginger Woolley

              Oct 2018, L3 - S1, Anterior & Posterior, Dr Sigurd Berven, UCSF, San Francisco
              ******
              May 2008, T4 - L3, Dr. Ohenaba Boachie, Hospital for Special Surgery, NYC
              ******
              Sept 1967, T4 - T 11, without instrumentation, Dr Thomas Brown, Stanford

              Comment


              • #8
                Hi,

                I had a Thoracoplasty as a seperate procedure after my fusion. The surgeon removed the middle section of 5 ribs to reduce the hump. I thought after the surgery that my hump was much improved and was glad I got it done . I have never had any problems with it and dont notice any difference in my breathing. Only problem now is that my curve appears to be progressing slightlyand having being looking into surgery options I have been told because of the thoracoplasty it makes revision surgery more tricky as my lung capacity has been reduced by 20% and futher surgery would reduce it more.

                Amanda

                Comment


                • #9
                  Hi Ginger--I had a rib removed & rib hump corrected , but it was not discussed also. I guess at that point(pre-op), I did'nt know enough to ask about a thoracoplasty(knew nothing of it). I had full confidence, though, in my surgeon to do what was best for my case. I can say my back looks way better compared to before........Lynne

                  fused T-11 to L-5
                  Dr. Boachie/Kim at HSS/NYC
                  Aug 2006

                  Comment


                  • #10
                    Dear Ginger:

                    You may have read my previous post about thoracoplasty. I had extensive thoracoplasty in 1983 and 1987 for reduction of a large thoracic hump. While I do not know the specifics of the procedure, portions of the ribs were removed and have regrown in much straighter. The first procedure involved about 6-7 ribs and the second, three ribs. I was extremely pleased with the positive change in my appearance and the improvement in my self esteem. I am now 63 y.o. and like you had an uninstrumented fusion and plaster body cast at age 16 in l962. My thoracic curve is 97 and lumbar 70. I do have significant reduction in my lung capacity and sleep apnea which are probably due to a combination of factors: the high thoracic curve of 97; a high displacement of my trachea due to the high curve; a severe indentation of my right chest in the front; the previous rib resections (thoracoplasty). I am very pleased with the result of the thoracoplasty even with my current issues.
                    I am sure your scoliosis surgeon will do what is best for you. Dr. Boachie is so very experienced and highly regarded by his peers. Surgeons have learned so much over the years about surgery outcomes and consequences. You are in the best of hands. My revision surgery in June will be by Dr.Lenke,
                    also highly experienced and regarded.
                    Wishing you the very best.

                    Comment

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