John
P. Lubicky, M.D. Shriner's Hospital for Children
Chicago, IL Sometimes if the rib hump is small, the correction of
the curve will make it look better and nothing specific needs to be done. If
the rib hump is of moderate size, and the ribs are not particularly deformed,
something called the Cotrel costotransversotomy is performed. The ribs are attached
to the vertebrae on two points, one is the vertebral body, and the other is
the transverse process. In the Cotrel costotransversotomy, the transverse process
is cut at its base through the posterior incision, and this effectively removes
one attachment of the rib. The ribs can then rotate on the other attachment,
thus decreasing the rib hump. The last way of doing it is to actually remove
sections of rib, and this tends to be more effective and is certainly needed
in those situations in which the rib hump is very large and where the rib contour
is abnormal. This bone can then be used for the bone graft. It does help tremendously
in decreasing the rib hump. However, in those patients who have very severe
rotation of the vertebrae, even taking the ribs doesn't completely remove the
rib hump and there may be a slight prominence left.
Charles E. Johnston, II,
M.D. Texas Scottish Rite Hospital
Orthopedic Group This may occur as part of the straightening of the spine
itself, or may be done by removing segment of the ribs involved to collapse
the rib prominence.
Dr. Frank J Schwab
New York, NY
At the time of scoliosis correction, the rib hump is usually corrected to some extent. If the spine is very flexible and the rib cage not very rotated, the rib hump may disappear post operatively. Occasionally, a mild to moderate rib hump may remain. At the time of surgery it is possible to reduce the rib hump with an additional procedure through the same incision. This additional technique is called a thoracoplasty and involves removal of rib segments at several levels.
Dr. Baron S Lonner
New York, NY
The rib hump is corrected as part of the scoliosis operation. This is at times achieved simply with the instrumented correction by derotating the spine and allowing the chest wall to correct with this maneuver. At times, the rib hump is large and rigid and longstanding in nature and will require a formal procedure termed thoracoplasty to address the rib hump. Thoracoplasty is done during the same operation as the instrumentation and involves removing 3-inch segments of up to 5 or 6 ribs. The ribs most often will grow back fully and the procedure has no long-term negative effects on pulmonary function and breathing.
John T. Smith, M.D. University of Utah
Department of Orthopaedic Surgery Rib humps do tend to improve significantly with surgery,
but do not completely go away. If one desires a rib hump to be corrected, then
a procedure called a thoracoplasty is performed. This is a procedure in which
the ribs are removed from their sleeve of periosteum, which is the protective
tissue around the rib. The ribs will then grow back spontaneously, but in a
new position.
Dr. Stephen Ondra Chicago, IL Often, the rib hump is the most cosmetically undesirable part of a scoliotic deformity. Even with correction of spinal curvature, a significant rib hump can remain. A thoracoplasty is an operation done to remove this rib hump. Muscle and skin are dissected off the area of the hump, through the same incision that the spine correction used. The ribs are then dissected free of the lung covering and removed from the spine to the top of the hump. In this way, the ribs will flatten out and take a more normal contour. This causes some very minor lung dysfunction that typically causes the patient no change in their activity level or function. It is associated with some increased pain after surgery. Despite this, most patients find the improvement in their cosmetic appearance worth this temporary trouble.
Michael
F. O'Brien, M.D. Denver Orthopaedics The rib hump is corrected to some degree during scoliosis
surgery. Ideally, the rib hump will disappear once the curve is decreased with
placement of the instrumentation. Occasionally this is only incompletely accomplished
via this technique and the residual rib hump is then removed surgically. This
is typically done through the same incision. Using either technique it is typical
to get excellent cosmetic correction of the rib asymmetry.
Thomas
G. Lowe, M.D. Woodridge Orthopaedics & Spine Center, P.C. When I do the scoliosis surgery, I almost always also
correct the rib prominence as it is the part of the deformity that shows the
most. If the scoliosis is severe, which means greater than 50º, usually the
rib hump will not be fully corrected by correcting the spinal curvature. Correction
of the rib hump is done through the same incision and does not require any additional
skin incision. It is done by removing a small segment of the rib, or removing
a small piece of four or five ribs surrounding the scoliosis deformity. This
results in a small amount of additional discomfort during the first 2-3 days,
but most patients really cannot feel that it has been done.
David W. Polly, Jr., M.D. Minneapolis, MN The "rib hump" is corrected by correcting the curve and
sometimes by taking out pieces of the ribs. They usually grow back but a little
bit flatter than before.
Jean-Pierre C. Farcy, M.D. M.M.C. Spine Center
New York, NY Correcting the rib hump can be achieved by derotation
of a supple curve if the rib hump is small, however if the rib hump is more
pronounced a thoracoplasty can be performed (resection of ribs segments).
Edgar G. Dawson, M.D. The Spine Institute
Santa Monica, CA Many patients would like to have the rib prominence corrected
when they have a thoracic scoliosis. There are several ways of doing it, but
most require some rib removal. This is interesting because the ribs will actually
reform in a different shape so that your chest will not be vulnerable. Many
surgeons do rib prominence or rib hump resections on almost every patient.
Dr. James Mooney, III Detroit, MI A portion of the rib hump may correct with correction of the spine. However, some portion of the deformity is fixed and can only be corrected by resecting portion of the ribs. This can be done at the time of the procedure or at a later date, and is called a thoracoplasty.
