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I want my rib hump corrected. How is this done

Dr. Frank J. Schwab

New York, NY

At the time of scoliosis correction, the rib hump is usually corrected to some extent. If the spine is very flexible and the rib cage not very rotated, the rib hump may disappear post operatively. Occasionally, a mild to moderate rib hump may remain. At the time of surgery it is possible to reduce the rib hump with an additional procedure through the same incision. This additional technique is called a thoracoplasty and involves removal of rib segments at several levels.

Dr. Scott J. Luhmann

St. Louis, MO

The correction of the scoliosis is achieved by several inter-related techniques during the surgery, which can also secondarily decrease the rib hump. If the rib hump is perceived as a significant part of the overall deformity, a derotation maneuver can be additionally performed, which directly corrects the abnormal scoliotic spinal rotation and thereby decreases the rib hump significantly. If this cannot be done, a thoracoplasty can be done. In this procedure, a section of the most prominent ribs can be removed to minimize the rib hump, with the ribs regrowing in a much more normal position.

Dr. John P. Lubicky

Chicago, IL
Shriner's Hospital for Children

Sometimes if the rib hump is small, the correction of the curve will make it look better and nothing specific needs to be done. If the rib hump is of moderate size, and the ribs are not particularly deformed, something called the Cotrel costotransversotomy is performed. The ribs are attached to the vertebrae on two points, one is the vertebral body, and the other is the transverse process. In the Cotrel costotransversotomy, the transverse process is cut at its base through the posterior incision, and this effectively removes one attachment of the rib. The ribs can then rotate on the other attachment, thus decreasing the rib hump. The last way of doing it is to actually remove sections of rib, and this tends to be more effective and is certainly needed in those situations in which the rib hump is very large and where the rib contour is abnormal. This bone can then be used for the bone graft. It does help tremendously in decreasing the rib hump. However, in those patients who have very severe rotation of the vertebrae, even taking the ribs doesn't completely remove the rib hump and there may be a slight prominence left.

Dr. James Mooney, III

Detroit, MI

A portion of the rib hump may correct with correction of the spine. However, some portion of the deformity is fixed and can only be corrected by resecting portion of the ribs. This can be done at the time of the procedure or at a later date, and is called a thoracoplasty.

Dr. Charles E. Johnston, II

Texas Scottish Rite Hospital Orthopedic Group

This may occur as part of the straightening of the spine itself, or may be done by removing segment of the ribs involved to collapse the rib prominence.

Dr. Patrick Bosch

Albuquerque, NM

Rib hump correction usually occurs with scoliotic curve improvement. Especially with the newer “de-rotational” techniques, correcting spinal rotation untwists the rib rotation, which causes the hump. In some instances, if the rib prominence remains, a thoracoplasty - or partial rib resection - can be done.

Dr. Michael F. O'Brien

Denver Orthopaedics

The rib hump is corrected to some degree during scoliosis surgery. Ideally, the rib hump will disappear once the curve is decreased with placement of the instrumentation. Occasionally this is only incompletely accomplished via this technique and the residual rib hump is then removed surgically. This is typically done through the same incision. Using either technique it is typical to get excellent cosmetic correction of the rib asymmetry.

Dr. W. Christopher Urban

Glen Burnie, MD

A rib hump is partially corrected by straightening the scoliosis curve. A more substantial rib hump correction may be achieved through an additional procedure. This procedure, called a thoracoplasty, is done through the same incision as the scoliosis correction surgery. It involves resecting (surgically removing) a portion of the rib cage so that the hump flattens out. As the ribs grow back, they are less prominent and have a more natural shape (cosmesis). A thoracoplasty usually causes a small temporary decline in pulmonary function after surgery.

Dr. David W. Polly, Jr.

Minneapolis, MN

The "rib hump" is corrected by correcting the curve and sometimes by taking out pieces of the ribs. They usually grow back but a little bit flatter than before.

Dr. Robert S. Pashman

Los Angeles, CA

A rib hump is produced when the chest wall rotates as the spine curves. In many cases, surgical correction of the spinal curve may reduce enough of this rotation to produce a cosmetically acceptable decrease in the rib hump. If the hump is not decreased to an acceptable level, I will remove segments of the ribs and use them as bone graft material. This procedure, which is called thoracoplasty, can produce an excellent cosmetic result.

Dr. Stephen Ondra

Chicago, IL

Often, the rib hump is the most cosmetically undesirable part of a scoliotic deformity. Even with correction of spinal curvature, a significant rib hump can remain. A thoracoplasty is an operation done to remove this rib hump. Muscle and skin are dissected off the area of the hump, through the same incision that the spine correction used. The ribs are then dissected free of the lung covering and removed from the spine to the top of the hump. In this way, the ribs will flatten out and take a more normal contour. This causes some very minor lung dysfunction that typically causes the patient no change in their activity level or function. It is associated with some increased pain after surgery. Despite this, most patients find the improvement in their cosmetic appearance worth this temporary trouble.

Dr. John T. Smith

University of Utah Department of Orthopaedic Surgery

Rib humps do tend to improve significantly with surgery, but do not completely go away. If one desires a rib hump to be corrected, then a procedure called a thoracoplasty is performed. This is a procedure in which the ribs are removed from their sleeve of periosteum, which is the protective tissue around the rib. The ribs will then grow back spontaneously, but in a new position.

Dr. Robert W. Molinari

Rochester, NY

The rib hump is typically corrected when instrumentation is utilized to correct the spinal curvature.

Dr. Thomas G. Lowe

Woodridge Orthopaedics & Spine Center, P.C.

When I do the scoliosis surgery, I almost always also correct the rib prominence as it is the part of the deformity that shows the most. If the scoliosis is severe, which means greater than 50Âş, usually the rib hump will not be fully corrected by correcting the spinal curvature. Correction of the rib hump is done through the same incision and does not require any additional skin incision. It is done by removing a small segment of the rib, or removing a small piece of four or five ribs surrounding the scoliosis deformity. This results in a small amount of additional discomfort during the first 2-3 days, but most patients really cannot feel that it has been done.

Dr. Jean-Pierre C. Farcy

New York, NY
M.M.C. Spine Center

Correcting the rib hump can be achieved by derotation of a supple curve if the rib hump is small, however if the rib hump is more pronounced a thoracoplasty can be performed (resection of ribs segments).

Dr. Dennis G. Crandall

Mesa, AZ

Your rib hump will be significantly better when your curve is corrected. In rare cases when the hump is still prominent, it can be corrected by removing a small section of the involved ribs through the same incision as the scoliosis surgery.

Dr. Baron S. Lonner

New York, NY

The rib hump is corrected as part of the scoliosis operation. This is at times achieved simply with the instrumented correction by derotating the spine and allowing the chest wall to correct with this maneuver. At times, the rib hump is large and rigid and longstanding in nature and will require a formal procedure termed thoracoplasty to address the rib hump. Thoracoplasty is done during the same operation as the instrumentation and involves removing 3-inch segments of up to 5 or 6 ribs. The ribs most often will grow back fully and the procedure has no long-term negative effects on pulmonary function and breathing.

The commentary above recounts the experiences of these physicians. Medtronic invited them to share their stories candidly. Keep in mind that results vary; not every patient's response is the same. Talk with your doctor to learn more about any products that are mentioned above.

It is important that you discuss the potential risks, complications and benefits of spinal surgery with your doctor prior to receiving treatment, and that you rely on your doctor's judgment. Only your doctor can determine whether you are a suitable candidate for this treatment.

  • Published: June 20, 2002
  • Updated: April 19, 2010