SSO Guide to the Costoplasty procedure
Since we get asked about Costoplasty surgery very often here at SSO, the staff have put together this post so that it is easy to refer to it for information. This post is locked, but if you have any questions or concerns regarding Costoplasties then please do start a new thread in the General Forum
NB please note that the correct spelling of this procedure is COSTOPLASTY, THORACOPLASTY or COSTECTOMY. It's very often misspelt, but it's important to use the correct spelling if you are doing searches either here at SSO or on the Internet in general, so that you can find the information that you need.
The Costoplasty Procedure
A Costoplasty is a surgical procedure that is done to reshape the ribcage and lessen the appearance of a rib hump associated with scoliosis. Whilst this procedure is generally called a "Costoplasty" in the UK, in other parts of the world - such as the USA - it is often referred to as a "Thoracoplasty". You may also sometimes find it referred to as a "Costectomy". These are all names for the same procedure.
During a Costoplasty small sections of the ribs at the apex of the rib hump are cut out and removed. The intercostal muscles - i.e. the "sleeves" of muscle that surround each rib - are sewn back together and the cut ends of the ribs eventually heal together, creating a new, flatter profile. Occasionally, the intercostal muscle is removed - in which case, the rib will not grow back. This is sometimes done to permanently remove a rib from the bottom of one side of the ribcage, in order to create a more even appearance.
A Costoplasty may be done at the same time as a spinal fusion surgery, or it may be done on its own as a standalone procedure at any time afterwards. It is therefore possible to have the surgery done many years after you have had your spinal fusion. The bone that is removed during a Costoplasty may be used as fusion material if a spinal fusion surgery is being done at the same time.
In rare cases, a Costoplasty may be done on a patient who has not had their thoracic spine fused beforehand. However, there is a risk that their thoracic curve may progress and cause the cosmetic correction of the Costoplasty to be lost. If your consultant wishes to perform a Costoplasty without fusing your thoracic spine first, do ask about the risk of future progression and make sure that you are comfortable with your consultant's reasons for doing so.
A small number of people are not able to have a Costoplasty despite having a large rib hump. This may be because their lung function has become greatly compromised by their scoliosis, or because they have other respiratory issues. Any surgery on the ribcage causes a further temporary drop in lung function, so it would be too dangerous for these patients to have the surgery.
The cosmetic results of a Costoplasty can be dramatic and most people are very pleased with the results that their surgery has acheived. However, it is important not to expect total perfection, especially if you've had a large deformity before. The cosmetic results of a costoplasty depend on how much the spine still rotates out into the rib hump; it is not possible to completely flatten the hump if there is rotation present, because the spine is in the way.
People with older style instrumentation (such as Harrington Rods) often still have a lot of rotation post-op because the rods couldn't untwist the spine, so they tend to have small rib humps even after having a costoplasty. Patients with modern hardware (such as pedicle screw systems that are typically used today) generally get much better results because the instrumentation can derotate the spine, but it is still possible for some rotation to remain.
Recovery from Costoplasty surgery is known for being very painful. This is because not only are the ribs broken, but the intercostal muscles have been cut through too. However, the pain is generally only severe for the first 2-3 weeks, and most people find that it has improved greatly by week four. Your hospital or GP should be able to prescribe you suitable painkillers to keep you reasonably comfortable, but pain is to be expected. Coughing, sneezing, and yawning can be extremely painful and it is recommended that you hug a pillow whilst doing so!
37 years old, diagnosed with infantile idiopathic scoliosis at 6 months old with curves of 62(T) and 40(L) degrees. Casting and Milwaukee braces until surgery at 10 - ant release/pos fusion T1-T12, halo traction. Post op cast and then TLSO. Further surgery at 18 (ant release/pos fusion extended to L3 to include lumbar curve, costoplasty) and 25 (another costoplasty). Fusion extended to L4 at 33 (XLIF with 4 pedicle screws and two short rods). Pre-op curves: 76(T) and 70(L). Post-op curves: 45(T) and 35(L). Diagnosed with Ehlers-Danlos Syndrome aged 34; scoliosis almost certainly due to this rather than being idiopathic.