thoracic rotation

[Jimbo]

Helloooooo, just a quick question for anyone who may know the answer. Can fusion alone reduce the posterior rib hump, without getting the thoracoplasty. My lumbar is where the curve degree is most at 40, but I have a thoracic curve at 25 degrees. Although the thoracic curve is small, the rib hump is noticable, especially if I bend forward. What are the chances that this may be reduced with fusion? Thanks guys :)

[Pooka1]

Modern instrumentation can greatly reduce a rib humps caused by thoracic curves at least as it did for my daughter.

She had a noticeable hump and now it is barely there and not likely noticeable unless you knew what to look for.

She had no ribs removed.

I wonder if your surgeon will fuse the thorax region solely to reduce the rib hump if the curve there is compensatory. Maybe, just as other compensatory curves improve when the structural curve is fused, your rotation will improve without fusion.

It's a question for your surgeon.

[Suzy]

Hey Jim,

I had a 49* lumbar curve and thoracic rotation that is completely gone now. I had no compensatory T curve. I am fused T10 to L4, straightened out to 8*. I had a pretty good rib hump when I bent forward, not any more!

[debbei]

Hi Jimbo,

I'm not really sure, but I have a 66 degree thorasic curve, and my surgeon said that I do not need a thoracoplasty. Of course, my rib hump isn't so bad to begin with. Sorry I was no help,

[Susie*Bee]

I have heard and read that it doesn't necessarily correct the rib hump... and some who saw theirs diminish post-op had it return to some extent later. It's not a given. You probably need to ask your surgeon about it. Sorry to be a wet-blanket...

[Jimbo]

Thanks folks, you are a great help and it is much appreciated.

I have noticed that alot of the positives and negatives with this surgery are not really known untill post-op, and sometimes a long while post-op. Bit of a leap of faith, oh well, I like hospitals, that is an advantage.

[dolores a]

Sorry if I sound not too educated yet to all the terms and so forth, but when you say posterior rib hump is this located on the back up toward the shoulder. And what do you call the ribs that that are more prominent in the front. I also have a lumbar curve 48 or 49 with a smaller thoracic 28 or 38, but my ribs on my left side in the front (anterior?) are starting to really show!

[Jimbo]

You are correct dolores. Posterior is back, anterior is front. My rib hump ( god I hate that term, maybe posterior thoracic malformation sounds better, mmm) is upper right, but you can really only notice it when I bend down. Your ribs in the front are showing hey, never heard of it but I am sure it is possible, maybe even common. As the rib cage rotates around, you could have a rib deformity anywhere around the thorax. Are you considering surgery?

[Theresa]

dolores a,

My rib cage on the left side sticks out a lot in the front!!! After my first surgery the ones in front didn't stick out but the ones on the right side in the back did! They really bothered me when you sat in a high back chair. Before the second surgery I had mentioned this to my doctor and he did some adjusting to the ribs so they weren't so noticeable on either side. After the third surgery we are back to having them stick way out in front on the left again. This is part of the problem of never being braced. My rib cage is so deformed no matter what you do, they will stick out somewhere!!!!

[dolores a]

Hi Jimbo,

If I am reading your post correctly, it sounds like you have similiar curves as I do, (sounds funny!) but I don't have any noticeable "thoracic malformation ", just the ribs in the front being more prominent. Acutally, I am not considering surgery, but if the spine surgeon that I am seeing next week also says that I will need surgery, then I guess I will have to consider it. He will be my 2nd opinion, hoping he'll say that I do not need the surgery.

[Peachy]

Jimbo,

I have a rather large rib hump that I am hopeful of having corrected along with my 80-degree curve. I asked my surgeon if he thought his "de-rotating" my spine would take care of the hump. He smiled, patted my hand, and said that that works best in children, but will not help me because my spine is too stiff and my ribs have been displaced for so long.

He will do a thoracoplasty, removing probably one rib. I don't mind this though (yes, I know rib removal is painful) :( , but he will use the rib as part of the bone for grafting (along with donor bone), and this will allow him to avoid removing grafting bone from from my pelvis (which can also cause pain). In my case, I look at this particular procedure as being a good trade-off for me.

Of course, your thoracic curve is much smaller than mine and your bones may be a lot more flexible too, so you'd probably do better than I would. Best wishes to you.

Peachy

[dolores a]

Hi Theresa,

Sounds like its not an exact science how one will align after surgery! Question though, I actually do have a bump or hump on my left side on the back about the middle, I thought this was muscle from overcompensating everything, my regular ortho told me that it was actually my spine. Now that I look at what I typed, not sure what my question was, I guess what I'm trying to figure out is is this a hump that everyone is talking about?

[debbei]

Hi Theresa,

Sounds like its not an exact science how one will align after surgery! Question though, I actually do have a bump or hump on my left side on the back about the middle, I thought this was muscle from overcompensating everything, my regular ortho told me that it was actually my spine. Now that I look at what I typed, not sure what my question was, I guess what I'm trying to figure out is is this a hump that everyone is talking about?

Dolores,

Maybe I'm wrong since I'm not so familiar with all the lingo, so someone else can correct me if needed, but I THINK the rib hump is really in the upper part of your back, where your shoulder blade is. I think the 'middle' hump that you are talking about, (I have too), is really your spine out of place.

[Theresa]

dolores a,

Here is a link (http://www.jbjs.org.uk/cgi/reprint/58-B/1/64.pdf) to a site that talks about the rib hump and how to measure it. There really hasn't been to many of us that have talked about the ribs sticking out in the front. I have asked the doctor if something can be done about it. They do try to help it somewhat when they are adjusting and aligning your spine when they are doing the surgery. I was also told that a thoracoplasty is more for the younger ones, it's more likely that they will have a good outcome because there is not much permanent deformity to their ribs yet. A thoracoplasty (http://www.iscoliosis.com/treatment-surgical-thoracoplasty.html) is when they try to decrease the rib hump by cutting out the sections of the ribs at their apex, hoping that they will grow back in straighter. Then there is a thoracotomy. That's where they do an incision through the side of the chest wall, take out of whole rib or two, deflate your lung to get at the anterior portion of your spine. The rib is then crushed up and used along with your hip graft, and or donor bone or synthetic bone and placed in cages that are placed into your disc space when they remove disc material in order to give your spine some flexibility.

[Jimbo]

My god Theresa, that thoracotomy sounds so hardcore! I am gonna ask my surgeon about what he thinks is my best option. I don't think he will want to operate on me though as my curves are "small". Oh well, I am gonna stop dwelling on this and go out somewhere. Ya'll take care.



dolores a,



Here is a link (http://www.jbjs.org.uk/cgi/reprint/58-B/1/64.pdf) to a site that talks about the rib hump and how to measure it. There really hasn't been to many of us that have talked about the ribs sticking out in the front. I have asked the doctor if something can be done about it. They do try to help it somewhat when they are adjusting and aligning your spine when they are doing the surgery. I was also told that a thoracoplasty is more for the younger ones, it's more likely that they will have a good outcome because there is not much permanent deformity to their ribs yet. A thoracoplasty (http://www.iscoliosis.com/treatment-surgical-thoracoplasty.html) is when they try to decrease the rib hump by cutting out the sections of the ribs at their apex, hoping that they will grow back in straighter. Then there is a thoracotomy. That's where they do an incision through the side of the chest wall, take out of whole rib or two, deflate your lung to get at the anterior portion of your spine. The rib is then crushed up and used along with your hip graft, and or donor bone or synthetic bone and placed in cages that are placed into your disc space when they remove disc material in order to give your spine some flexibility.

[dolores a]

I know this Thread was Jimbo's, but it certainly cleared some things up for me also, I will add this topic to the list of questions that I am bringing with me to the surgeon next week. Thanks everyone!