Scoliosis Surgery: Rib Hump and Curve Correction

Thoracoplasty (Rib Resection)
Patients with scoliosis often have a prominent rib hump. One of the goals of corrective scoliosis surgery is to correct the rib hump. Thoracoplasty is a surgical procedure that helps to reduce rib hump size. The procedure involves partially removing as many as five ribs. This procedure is usually performed as part of the scoliosis surgery, but may be performed at a later time. Sometimes a chest tube drain is needed for a day or two after thoracoplasty is performed. Thoracoplasty is less commonly performed today than before because current advances in spinal instrumentation results in improved rotational correction of the deformity.

Osteotomies (Cutting and Removing Bone)
The term osteotomy means cutting into and removing bone. Osteotomies are performed in the front or back of the spine. In treating scoliosis curves, an osteotomy is used to improve correction of the spinal deformity. Osteotomies are used to treat adults with rigid scoliotic curves, children with large curves causing deformity, flatback correction, and in spinal reconstructions where realignment is needed after a prior spinal fusion.

Osteotomies (below): Osteotomies were performed using thoracoscopy in the anterior (front) spine and then from the back (posterior) in this 35-year-old female patient. The patient had severe and painful kyphosis.

Before surgery 85°

After surgery 43°

Hemivertebrae Excision (Removal)
A hemivertebra is a wedge-shaped vertebral body. A normal vertebra is shaped like a rectangle. This abnormality forms before birth and may result in scoliosis or kyphosis as the individual grows. If scoliosis or kyphosis is progressive, and the patient is off balance, the abnormally shaped vertebra can be surgically removed. The surgical procedure is performed using an anterior-posterior approach or, more commonly today, solely from a posterior approach. The instrumentation (e.g. rods, screws) is implanted posteriorly and patients are often braced for several months after surgery.

Hemivertebrae Excision (Removal) (below): An 11-year-old female with a 49 degree curve due to a hemivertebra was removed by an anterior-posterior approach straightening the curve to 10 degrees.

Before

Before

After

After