Every year, the National Scoliosis Foundation receives queries
about rib thoracoplasty, a surgical technique sometimes used to
help patients with scoliosis who also suffer from a "rib hump".
To find out more about the procedure, NSF asked Dr. Serena S. Hu,
Assistant Professor, Department of Orthopaedic Surgery at the University
of California, to respond to a number of questions. What follows
are excerpts of her responses, which have been edited by Nancy Schommer,
author of Stopping Scoliosis.
Q: What exactly is a rib thoracoplasty and why is it performed?
A: Simply stated, a rib thoracoplasty involves shortening of certain
ribs in the thoracic or chest area. It is done to reduce the size
and severity of a rib hump which may accompany scoliosis. The procedure
is usually performed after the patient has had corrective surgery
Q: What are the goals of a rib thoracoplasty?
A: For moderately severe deformities, the procedure appears to result
in a significantly greater improvement in a patient's overall appearance,
though it will not result in perfect symmetry. The procedure also
relieves pain that may be associated with a rib hump, such as when
an individual leans up against a chair.
Q: Are there a lot of different surgical techniques being used
today for a rib thoracoplasty?
A: As far as I know, most surgeons use fairly similar techniques.
However, some surgeons make an incision over the peak of the rib
hump, whereas I prefer, as do many others, to use a midline incision-that
is, to use the same incision that's used for a posterior spinal
fusion. Patients seem to prefer having a single midline incision.
Q: What determines which ribs are shortened, and how do you
decide how much to shorten them?
A: We determine which ribs are shortened based on which ones are
prominent and are not expected to be reduced by correction of the
curvature. As far as deciding how much to shorten ribs, we decide
on a case by case basis; it depends on the nature of a patient's
curve, as well as the severity of the rib hump.
Q: When the ribs grow back after surgery, do they actually form
new rib bone and reconnect to the spine, and how long does it take
for this to happen?
A: Yes, the ribs do grow back, forming a new rib. This takes approximately
two to three months.
Q: Is the new growth as strong as the original rib?
A: The new rib, once it is completely healed, will be as strong
as the original rib.
Q: Is there any chance of the rib hump returning?
A: That would only occur if the curvature progresses.
Q: Could a rib grow back crooked or out of place?
A: This is rarely, if ever, encountered.
Q: Is it always necessary to wear a brace following this surgery?
Will wearing or not wearing a brace affect the outcome of the surgery?
A: The use of a brace appears to protect the ribs from rubbing against
the chest cavity and seems to result in less likelihood of fluid
collection and the subsequent need for a chest tube. Not wearing
a brace will not affect the long term outcome of the surgery, but
in the short term a brace could avoid the complications as mentioned.
Q: During recovery, is there any danger for the unprotected
A: Not in the course of normal activities. There might be a theoretical
risk of a very forceful blunt trauma causing damage, but this would,
of course, be very unusual.
Q: Can a patient damage the rib cage during recovery by stretching
or moving incorrectly? Are there any movement restrictions once
the healing is complete?
A: A patient wouldn't damage the rib cage during the course of normal
activities. Once healing is complete, there are no movement restrictions.
In fact, tennis and golf would be possible within the constraints
of spine fusion limitations.
Q: How long is recovery time?
A: For patients who choose to undergo thoracoplasty surgery as a
separate procedure, full time in hospital is 5 to 7 days; recovery
is 2 to 3 months for this procedure.
Q: Aside from the risks of anesthesia, what are the possible
complications from this procedure, and what can be done about them?
A: The main complications would be: fluid or air collection in the
lungs, both of which can be treated with a special device called
a chest tube. There might be too much resection resulting in a rib
concavity, and there could be a temporary decrease of lung capacity.
Q: Can a patient go back to surgery after the corrective spine
surgery and have a rib thoracoplasty done?
A: Yes, many patients elect to have the thoracoplasty performed
after recovery from their major spinal corrective surgery.
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