Safety and efficacy of intraoperative vectored cranial traction with Gardner-Wells tongs for pediatric spine deformity surgery.
Document Type
Article
Publication Date
11-1-2026
Identifier
DOI: 10.1097/BPB.0000000000001366
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 OF EVIDENCE: Level IV.
Journal Title
Journal of pediatric orthopaedics. Part B / European Paediatric Orthopaedic Society, Pediatric Orthopaedic Society of North America
Volume
35
Issue
6
First Page
517
Last Page
522
MeSH Keywords
Humans; Traction; Child; Female; Child, Preschool; Adolescent; Male; Retrospective Studies; Treatment Outcome; Postoperative Complications; Prone Position; Pressure Ulcer; Intraoperative Care
PubMed ID
42290061
Keywords
Gardner–Wells tongs; adolescent idiopathic scoliosis; spine surgery; vectored traction
Recommended Citation
Sardesai KS, Georger L, Dumas A, Noe M, Schwend RM. Safety and efficacy of intraoperative vectored cranial traction with Gardner-Wells tongs for pediatric spine deformity surgery. J Pediatr Orthop B. 2026;35(6):517-522. doi:10.1097/BPB.0000000000001366
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