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Old 18-07-2012, 12:46 PM
Christine Christine is offline
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Join Date: Mar 2010
Posts: 268
Default Thoracoplasty question

Dear Doctor

I recently had 5 ribs attended to and I am curious about the procedure. And I am very happy my hump appears to have gone and I hope it is gone for good!

From my surgeons consult I understood that the ribs are cut where they are deformed, and just left to heal up again i.e. somehow grow back and cover the gap.

My GP told me yesterday his idea of the procedure is that they join the ribs up and wire them together, so there is no gap.

What is commonly done in this procedure? Join the dots? Or leave it open? Just wondering.

I can't really tell as I am too sore to look or feel anything! And Googling is not providing much in the way of answers.

Old 05-09-2012, 04:35 PM
Dr Scoliosis Dr Scoliosis is offline
Join Date: Apr 2009
Posts: 187
Default Re: Thoracoplasty question

The major outward deformity in thoracic scoliosis is the rib prominence which becomes more marked on bending forward. Hence, the Forward Bend Test in detecting scoliosis. As the spine bends sideways it rotates and rotation is one of the key components of the scoliotic spine. The ribs which articulate with the spine follow it passively. On the convex side of the curve the ribs move upwards and backwards so the rib prominence is away from the true mid line.

In certain cases when the rib prominence is very marked or quite angular there is a place for costoplasty, otherwise known as thoracoplasty, in an attempt to reduce the size of the rib prominence. This may be carried out as part of the original procedure of spinal fusion or perhaps at a later date. If it is done in adult life it will be through an incision over the sharpest part of the prominence. Usually to maximise the benefit of the procedure at least five ribs must be attended to. In the operation, as shown in the diagram, the shaded part of the rib is removed and the two ends are pressed downwards and joined by wires through drill holes.

The ribs have an outer bone-forming layer called periosteum which functions like bark on a tree. The periosteum is split and the section of rib to be removed is easily gained. Ribs have very good healing potential and the procedure offers little in the way of technical difficulty.

For smaller curves obviously the cosmetic improvement will be slight. It is to be emphasised that it is a cosmetic procedure. It is always prudent for anyone contemplating having a costoplasty to meet with a patient who has undergone the procedure.
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Old 06-09-2012, 07:05 AM
Christine Christine is offline
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Join Date: Mar 2010
Posts: 268
Default Re: Thoracoplasty question

Thank you for that very informed reply.

It makes sense as to why I am feeling so much discomfort! I must admit I am feeling a bit better knowing it is all wired together so as to reduce the likelihood of the dreaded hump returning. It is still looking good, with a lesser amount of shoulder blade protruding than before surgery. Hopefully I will be able to live with that, start some physio to get the muscles working again soon to help my shoulder sit flatter.

My surgeon went through the same posterior incision done for my fusion last year, so I only have the one scar which has healed up again nicely.

Again, thank you very much!

Christine x

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