Transverse process wiring for thoracic scoliosis

Abstract

We describe a method of reducing neurological risk by avoiding neural elements when performing segmental spinal fixation for scoliosis. This was done by making use of the transverse processes of the thoracic vertebrae 1–11 and wired plates. The wires are prevented from cutting the bone by attaching them to rectangular plates. These wired plates on the two sides of each segment should be firmly fixed to the base of the transverse process by tying them to each other. Maximum correction is obtained by spreading the force applied by stabilizing each thoracic vertebra from both sides. Derotation is attempted when all the wires have been tightened. Tension forces are spread to all fixated vertebrae simultaneously and the correction should be carried out at all levels at the same time. On the convex side, each wire connects over the rod to the next one above it and, tightened one by one, provides compression. We treated 15 patients having a thoracic curve with this method and followed them for 25–39 months. In 2 cases of congenital scoliosis, a 50% correction was obtained. In 3 cases of neurofibromatosis scoliosis, a 55% correction was achieved. In 10 cases of idiopathic scoliosis, the correction was 60%. When the thoracic sagittal contour was evaluated, thoracic kyphosis, which had been between −20" and +90°, had improved to between +8° and +43° in all cases. No infection or neurological complications occurred.