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 for scoliosis.

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 chest wall?

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.



