Thoracoplasty Procedure for Scoliosis

Patients with a so-called ‘rib hump’ due to an abnormal thoracic curve due to scoliosis may undergo a thoracoplasty procedure.  Also known as a costoplasty, this procedure aims to address the rotational deformity that these patients often have and may be performed as a stand-alone procedure or as part of wider back surgery for scoliosis.  A thoracoplasty is sometimes carried out in order to obtain bone graft material from the ribs of a patient (even when a rib hump is not present) in opposition to the use of bone taken from the hip/pelvis.  During thoracoplasty the surgeon usually excises four to six segments, about one or two inches in length, of adjacent ribs that are responsible for the rib protrusion.  The ribs are resectioned according to the surgeons’ judgement of their capacity for realignment following curvature correction or by their contribution to the deformity.

The ribs grow back straight, after removal, to align with the new spinal position, but the surgery can cause a reduction in lung function in some patients (10-15% typically).  Patients are also likely to experience increased pain in the chest following surgery and these complications may last a number of months, or up to two years.  The length of the thoracoplasty also presents problems associated with increased blood loss and anaesthetic exposure.  Operating in close proximity to the lungs, and the protective pleura covering the lungs, makes it possible that a haemothorax or pneumothorax occurs where blood or air drain into the chest cavity after the pleura is compromised.  This is rare, but remains a possibility during thoracoplasty.

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