Scoliosis or curvature of the spine can be severe enough to cause rib rotation as well. Rib cage deformity causes a rib hump to form that can be cosmetically unacceptable. But besides how it looks, the rib hump can also reduce pulmonary (lung) function.
As a result, surgery may be needed. The goal of surgery is to stabilize and balance the spine. If this goal is met, then the curve won’t get worse and the deformity will be corrected. The best way to achieve these goals isn’t clear. New developments in surgical instruments and methods are being reported.
In this study, thoracoplasty and the use of pedicle screws for scoliosis with rib hump is investigated. Thoracoplasty is the removal of ribs, which are then ground up and used as graft material for spine fusion. Pedicle screws are placed through the bridge of bone between the vertebral body and the back half of the vertebral segment. The pedicle forms part of the arch of bone that surrounds and protects the spinal cord.
Patients ages 11 to 19 with idiopathic scoliosis were included in the study. Idiopathic means there is no known cause for the problem. There were three groups based on type of surgical technique used to correct the deformity. Pedicle screw instrumentation was used in all three groups. One surgeon did all of the operations.
The first group had a spinal fusion using iliac crest bone for the graft. No ribs were removed (thoracoplasty was NOT done). Group 2 had a thoracoplasty and fusion but the spinal rotation was not corrected. Group 3 had a thoracoplasty, fusion, and derotation of the rib deformity. Special rods were used to distract the spine, correct the rib rotation, and realign the spine.
Results were measured using X-rays of spinal alignment (including rib hump and angle), pulmonary function, and self-image. The results showed better rib hump correction in the two groups who had the thoracoplasty. They also scored higher on tests for self-image (better self-image).
Two-year outcomes showed that the best way to correct rib hump associated with scoliosis in young patients is a thoracoplasty with direct vertebral rotation. Using the patient’s ribs accomplishes two things. It reduces the unacceptable rib hump. And it eliminates the need for the removal of bone graft material from the pelvic crest. Pulmonary function and self-image are also both improved.