View Full Version : Questions re ribs

18-04-2011, 10:12 PM

I'm a 20 year old male with scoliosis, 6 years ago it was 20 degrees (S shaped, more predonimant in the lumbar region, my ribs dig in if I lay on one side) and it hasnt gotten much worse since, although the rib cage deformity is quite large (one side of my rib cage is around 30%-40% smaller than the other side). I really want some improvement on the appearance of my rib cage I have a few questions regarding it. I have been to a orthopaedic surgeon in Brisbane and he basically said theres nothing that can be done. Although he did mention an implant for the rib cage (which he said are not satisfying) and a method of widening the base of the rib cage (don't know what this surgery is called).

1. Is there any surgery that can improve the appearance of the rib cage besides the correction of the spine itself

2. Is there any proven methods to improve the spinal deformity through less invasive surgery or other techniques

3. Do you think a pectoral implant (which would be placed underneath the muscle to even out the rib cage) would be wise? I have heard nothing but bad things about getting one done.

4. Is spinal surgery out of the question and why

Thank you very much for your response.

Dr Scoliosis
21-04-2011, 01:11 PM
Thank you for your enquiry.

Of course it is not possible to give you precise information without having the opportunity to examine you as I am sure you will appreciate. Hence, my remarks are based on general principles only.

On the information you have provided your problem is clearly a cosmetic one. This is always a difficult area but it is the patient's perception of the problem which is most important. A minor deformity of any type may be a totally consuming problem for a patient and it is quite inappropriate for a surgeon to dismiss the problem as trivial. Nevertheless, for any surgical procedure, and particularly a cosmetic one, the surgeon has to balance risks versus possible rewards in providing the advice.

From what you have said I am surprised that you have a significant deformity of your rib cage. This would be most unusual for a curve of 20 degrees.

In the first place, I think you would be well advised to see a spinal specialist and those who work in Brisbane are listed on our website (http://www.scoliosis-australia.org/scoliosis/scoliosis_specialists.html).

I can answer some of the enumerated questions you have set down:

Correction of the spinal deformity in itself is unlikely to significantly improve rib cage deformity.
In very severe rib deformities partial resection of the ribs (costectomy) can provide a significant cosmetic improvement. Clearly, your curve does not come into this category.
You need to discuss the possible role of a pectoral implant with a plastic surgeon and suffice it to say this procedure has a very limited role in the management of chest wall deformities.
A 20 degree curve is, in itself, a minor abnormality (nonwithstanding my former remarks about deformities generally) and this degree of curvature does not come into the surgical category. Given your stated age your curve should remain unchanged throughout life.

I trust this information is helpful.

Dr Scoliosis

23-04-2011, 05:39 PM
Hi, thanks for the reply Dr,

First of all I doubt my curve is currently 20 degrees, although the progression between 6 years ago and now has been very slow, I would assume it has gotten a bit higher, I should get it checked out and will look into a spinal specialist in Brisbane. Although I have a few questions on your response if you wouldnt mind.

I thought the disection of ribs was only beneficial if the spine was straight (or the ribs will grow out exactly the same).

"Correction of the spinal deformity in itself is unlikely to significantly improve rib cage deformity."

Is that true even when the result of the rib cage deformity is caused by the curvature of the spine? (my rib cage was symmetrical until my teenage years)

Also someone has messaged me saying that the procedure where they enlarge the ribcage is called a "Nuss." Are you familiar with this procedure and whether it may be beneficial for me?

Thank you.

Dr Scoliosis
02-05-2011, 03:21 PM
Your first enquiry was difficult to answer precisely and your response is even more so. Until you have your curve properly assessed it is difficult to give you reasonable answers to your questions. I regret that some of the questions that you have posed this time do not make any sense to me. I have no idea what you mean by "dissection of ribs was only beneficial if the spine was straight".

It is essentially correct to state that correction of a spinal deformity is in itself unlikely to significantly improve a rib cage deformity to any significant extent unless the spinal procedure involves derotation. That statement will not mean a lot to you and this emphasises the need for you to sit down with a spinal specialist to discuss your problem in some detail.

The rib cage deformity is secondary to the spinal deformity. Because the ribs are linked with the spine when the spine bends sideways and rotates the ribs follow.

Dr Scoliosis

14-05-2011, 10:55 AM

Thanks for the response. I understand the statement, I just thought the surgery corrected both rotation and curvature. In regards to the statement you didn't understand, I was asking if removal of ribs only helped cosmetically if the spine was already straight, or they would grow back in the same deformed manner. I will see a spinal specialist.


Dr Scoliosis
19-05-2011, 02:14 PM
Thank you for your further enquiry. In the circumstances I think it would be prudent to wait until you consult a spinal specialist and to then have your queries answered first-hand. The written word is sometimes quite an unwieldy vehicle for explanation.