Thoracoplasty

Scoliosis is a physical condition that causes the spine to take on an abnormal curve. When the curve occurs in the thoracic vertebra (i.e., the vertebra behind the chest), a "rib hump" often accompanies the curve. The hump results from the rib cage rotating along with the spine, altering the splay and contour of the ribs. Upon observation, the rib cages appear at different heights.

To determine if a patient has scoliosis, a physician observes the patient in a standing position and looks to see if the shoulder blades, hips, and ribs are at the same level on both sides of the body. A hump in the ribs can best be seen by asking patients to bend over and touch their toes.

The rib hump is corrected to some degree during spinal surgery. If any rib deformity remains after the surgery, the patient may elect to have a thoracoplasty performed. Thoracoplasty involves the surgical removal (resection) of rib segments. More specifically, this surgical procedure involves shortening certain ribs in the thoracic or chest area. The surgeon determines which ribs to shorten based on which ones (1) are prominent, and (2) are not expected to be reduced by correction of the curvature. The surgeon determines how much to shorten the ribs by based on the nature of the patient's curve and the severity of the rib hump. A shortened rib, once it has completely healed, is as strong as the original rib. Although thoracoplasty has traditionally been done through an open procedure (thoracotomy), it can be performed endoscopically.

The benefits of thoracoplasty include:

• Cosmetic correction of the rib hump deformity, i.e., reduction of the size and severity of the hump. It is important to note, however, that every thoracoplasty does not result in perfect symmetry.
• Relief of the pain associated with a rib hump.
• When performed at the same time as spinal surgery, thoracoplasty is an excellent source of bone, which can be used as a graft for spinal fusion.

Some patients elect to have a thoracoplasty performed after they have recovered from their spinal surgery. For patients who choose to undergo the thoracoplasty as a separate procedure, the hospital stay is usually 5 to 7 days; and the recovery time is around 2 to 3 months. In contrast, performing a thoracoplasty during spinal surgery does not prolong the patient's recovery period. The patient may experience a small amount of additional discomfort during the first 2 or 3 days, but many patients cannot even feel that it has been done.

It is important to discuss the potential risks, complications, and benefits of spinal surgery with your doctor prior to receiving treatment, and that you rely on your physician's judgment. Only your doctor can determine whether you are a suitable candidate for this treatment.