Recently, a reader asked me a question about a “rib clipping” procedure that a Doctor was recommending for her child. Since I had never heard of this during any of my previous research, I thought it would be helpful to dig into the issue a bit. It turns out that this procedure fits the definition of an osteotomy, which is a surgical operation where bone is cut to shorten, lengthen, or change its allignment. Osteotomies are sometimes used in Scoliosis surgeries for the more extreme cases, including in my daughter’s surgery. The type of osteotomy that Dr. Li performed on my daughter is called a Smith-Petersen Osteotomy. In layman’s terms, since my daughter’s vetebrae were misshapen (in a sort of wedge shape), Dr. Li and her team would have a difficult time straightening her spine as much as they would like. So, they wanted to perform the S-P Osteotomies (3 of them) to shave down some of the bone, smooth out the space between vertebrae, and allow her to get more correction. In our case, Dr. Li was only able to perform 1 of the 3 osteotomies because they lost signal to my daughter’s left leg during that time and they did not want to risk any permanent injury. Chances are that a neurological lead had slipped loose (that she was not actually experiencing neurological trauma), but, of course, Dr. Li made the right decision to stop the osteotomies at that point. However, she has performed them before and believes that they have benefit for more extreme cases like my daughter’s (who went into surgery with a 97 degree curve).
The type of osteotomy that the reader was ASKING me about, however, is a different type of osteotomy. I asked Dr. Li her opinion on them, and she graciously responded. Although she said that such procedures could probably be performed safely, they have been associated with greater blood loss and neurological complications and that she (and the other Doctors on staff at University of Michigan, specializing in spinal surgery) do not perform them. She also did not perform them while doing her pediatric orthopedic surgery training at Harvard. So, the practice at two renown hospitals and educational institutions is to NOT use Rib osteotomies when performing Scoliosis surgery. As she said, this is not to say that a Doctor who may be recommending one is not a good Doctor. My opinion is that, if your Doctor does happen to recommend a rib clipping procedure, that you may want to ask them why they think it is necessary. Also, ask them about the increased risk of blood loss and neurological issues, and ask if perhaps the Smith-Petersen Osteotomy may help instead. Sometimes they recommend rib osteotomies because of the rib humps that patients can develop. I have to say that my daughter, at 97 degrees, has ribs that are quite deformed. And, Dr. Li still did not recommend the procedure. My daughter will never be straight, and her ribs are NOT even, level, or symmetric. But, if an osteotomy is recommended simply for the purpose of correcting the appearance of the rib hump, you may want to seriously consider if that is worth the risk. In my opinion, procedures for improving one’s appearance are NEVER worth the risk, but everyone needs to make their own judgment calls on this topic. We didn’t even get more than 1 S-P Osteotomy done, but Dr. Li still got my daughter corrected from a 97 degree to a 40 degree curve, and we were still very happy with the results. My daughter’s appearance is fantastic, even with the slight asymmetry from the 40 degree remaining curve. I think it’s very important to find a Doctor whose plan you feel very comfortable with – I had that peace with Dr. Li and I would recommend her and her team at University of Michigan to ANYONE needing surgery. Having a surgeon and a surgery plan you trust are beautiful gifts. If you do not feel at peace with the recommendations of your surgeon, it just may mean they are not right for YOU. Feel free to seek out multiple opinions – doing your homework while establishing your team is essential and worth the time and effort.