Anterior Costoplasty (AIS)

As a scoliosis curve rotates, it pushes the ribs on the convex side backwards, producing the rib prominence — the rib hump — that is often the most visible sign of scoliosis and, for many young people, their biggest concern about how their back looks. Correcting the spinal curve improves the rib hump to an extent, but it does not always remove it completely, because the shape of the rib cage has itself been altered. Costoplasty, sometimes called thoracoplasty, directly reshapes the deformed ribs to reduce that prominence. It is done for the appearance and contour of the back, alongside the correction of the spine itself.

When I am already performing an anterior operation on the spine — for example an anterior release to loosen a stiff curve, or an anterior instrumented fusion — I have direct access to the rib cage from the front. In that situation, when a costoplasty is required, I perform it anteriorly, at the same sitting. Combining the rib reshaping with the anterior spinal surgery means the rib hump is addressed as part of the same operation, through the access I already have, rather than requiring a separate procedure. It is a considered addition, made when a significant rib prominence needs attention and the anterior approach is already being used.

Anterior costoplasty involves reshaping segments of the prominent, convex ribs so that the contour of the chest wall is smoother and more symmetrical. Performed through the same anterior access as the spinal surgery, it adds to that operation rather than being a stand-alone procedure. As with any surgery involving the chest, the lungs are protected and monitored, and the decision to include a costoplasty weighs the improvement in the shape of the back against the additional surgery involved.

The evidence shows that costoplasty reliably improves the objective size of the rib hump and improves patients' own ratings of their trunk appearance and self-image, beyond what correction of the spine alone achieves. Reshaping the ribs at the same time as anterior spinal surgery — including endoscopic and thoracoscopic techniques performed alongside an anterior release — gives durable cosmetic benefit. The main consideration the literature identifies is pulmonary function: costoplasty causes a temporary early reduction in breathing capacity, which in adolescents typically recovers over one to two years, though recovery may be less complete when it is combined with extensive anterior surgery or in older patients. For this reason, a costoplasty is generally reserved for those with a significant rib prominence and adequate breathing reserve, and the balance is considered for each individual.

Because a costoplasty involves the chest wall and is done alongside anterior spinal surgery, breathing is supported and monitored closely in the early days, and a temporary chest drain may be used. Some chest-wall discomfort in the area of the reshaped ribs is usual for a period and settles with time and pain relief. Beyond that, recovery follows that of the spinal operation it accompanies, with a graded return to normal activity over the following months. Many young people are pleased with the smoother, more symmetrical contour of the back once the rib hump has been reduced. The chest and spine are followed up over the longer term.

• —Barrios C, et al. Costoplasty in adolescent idiopathic scoliosis: objective results in 55 patients. (PMID 8245076)
• —The use of thoracoplasty in the surgical treatment of idiopathic scoliosis. (PMID 17108447)
• —Endoscopic thoracoplasty and anterior spinal release in scoliotic deformity. (PMID 10789035)
• —Video-assisted thoracoscopic surgery (VATS) for the treatment of scoliotic rib hump deformity. (PMID 17356821 / PMC2200748)
• —Pulmonary function after anterior double thoracotomy versus posterior surgery with costectomies in idiopathic thoracic scoliosis. (PMC3616475)
• —Analysis of pulmonary function and chest cage dimension changes after thoracoplasty in idiopathic scoliosis. (PMID 7676331)
• —Pulmonary function after thoracoplasty in adolescent idiopathic scoliosis. (PMID 12011704)
• —Pulmonary function after thoracoplasty in the surgical treatment of AIS. (PMID 20625329)
• —Short apical rib resection thoracoplasty compared to conventional thoracoplasty in AIS surgery. (PMID 24719039)
• —What are the effects of posterior corrective surgery, with or without thoracoplasty, on pulmonary function in AIS? Systematic review and meta-analysis. (PMC10240605)
• —Posterior spinal fusion with rib resection allows improved deformity correction and patient satisfaction. (PMID 40384585)
• —The influence of isolated thoracoplasty on pulmonary function after treatment of severe thoracic scoliosis. (PMID 28180979)