Safety and efficacy of intraoperative vectored cranial traction with Gardner-Wells tongs for pediatric spine deformity surgery.

Abstract

Pediatric spine deformity surgery in the prone position predisposes patients to pressure-related complications, ranging from ulcers to perioperative vision loss (POVL). Previous studies have identified that Gardner-Wells tongs with 15 lbs. of vectored traction at 45° elevation above horizontal can minimize facial pressure. We hypothesized that vectored traction would lead to a complication rate significantly lower than reported in the literature. Medical charts of 3088 consecutive patients undergoing spinal deformity surgery between 2008 and 2023 at a single site were queried. Cases in patients aged 2-18 years lasting more than 2 h (2680 patients) were included after confirming Gardner-Wells tong use. Charts were queried using complication-related keywords, and mean surgical time was compared between patients with and without complications (α = 0.05). A total of 38 (1.42%) cases had pressure-related complications: 17 facial abrasions (44.7%), 12 pressure sores/ulcers (31.6%), and nine instances of facial swelling (23.7%). There were no cases of POVL, cellulitis, abscess, or local infection. Complications were associated with longer surgery time (409 vs. 308 min; 95% confidence interval = 38.2-163.8; P < 0.005). Pressure-related complications were much lower with vectored traction compared with previous reports without facial elevation. All complications were minor and reversible, and POVL was not observed. Vectored traction with Gardner-Wells tongs is a safe and effective intervention for minimizing facial pressure during prone spine surgery. Level IV.