Does Scoliosis Surgery Correct Your Rib Hump?

The number one concern cosmetically for a person with scoliosis is the rib deformity that often accompanies a thoracic idiopathic scoliosis. The cause of this ribcage deformity is secondary to the spinal deformation. The reason ribcage deformity occurs is based on several biomechanical reasons. The main reason is that the spine and ribs are connected via joints, muscles, and ligaments so therefore changes in the spine will cause abnormal forces in the ribs leading to rib deformation. Scoliosis is a three dimensional deformity and is not merely a curved spine as opposed to a straight spine. The classic thoracic scoliosis with rib hump in adolescent idiopathic scoliosis occurs at a ratio of approximately seventy to eighty percent of cases leading to surgical intervention. Thoracolumbar and lumbar scoliosis curvatures most often do not exhibit enough abnormal forces upon the ribcage to create the cosmetic rib hump associated with primary structural thoracic curves.

The shape and size of the rib hump will vary depending on where the apex is and how many vertebral segments are involved with the overall thoracic curvature. Midlevel to lower apex locations from T8 through T10 will often cause a more noticeable rib hump deformity compared to thoracic apex locations that reside higher in the spine. In addition mid to lower apex locations often encompass more vertebrae in total that create the thoracic curvature thereby causing a more noticeable hump. It could be theoreticized that if scoliosis did not cause ribcage deformity that the attention placed on this condition would be substantially less and the rate of surgical intervention would drop significantly. There are only two symptoms that present with surgical level scoliosis, an increase in pain frequency as an adult, not pain intensity, and mild decreases in respiratory volume with scoliosis curvature greater than 60 degrees with anteriority.. So the so called "need" for surgery wouldn't be worth the potential risks. This being said the number reason patients and parents proceed is the rib hump deformity and its ability to create self image problems and the potential socioeconomic ramifications of not having a "normal" body form.

So does scoliosis fusion surgery correct the rib hump? The surgery itself without thoracoplasty where ribs are removed, will generally decrease ribcage deformity on an average of 30% often leading to a dissatisfaction in post surgery patients whose sole anticipation post surgery is cosmetic improvement. When thoracoplasty is performed in combination with posterior spinal fusion rib hump correction averages are 70% with patient satisfaction rates going up significantly. so why wouldn't all patients and surgeons agree to perform concomitant thoracoplasties to ensure rib hump reduction? The complications from surgeries performing both posterior spinal fusion and thoracoplasty are significantly higher and the rate of pulmonary deficiencies rises to levels equal to that of infused severe scoliosis curvatures which would defeat the entire argument to fuse because of potential pulmonary compromise if moderate 45-55 degree curves progress to severe levels at or near 80 degrees. Scoliosis Surgery with and without thoracoplasty is common practice in the treatment of adolescent idiopathic scoliosis and individuals considering this procedure need to understand the outcome and potential risks associated with achieving desired cosmetic improvement.