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Vectored Cranial-Cervical Traction Limits Facial Contact Pressure from Prone Positioning During Posterior Spinal Deformity Surgery

Koreckij, Jason, MD*; Price, Nigel, MD; Schwend, Richard M., MD

doi: 10.1097/BRS.0b013e3182012150
Cervical Spine

Study Design. Prospective, two-way complete block design analyzing facial contact pressures during prone positioning with the use of cervical traction for spinal surgery. Level 2 evidence.

Objective. To assess the effect of varying traction angle and traction weight to limit facial contact pressure.

Summary of Background Data. Posterior spine surgery has known hazards related to the prone positioning. Cervical traction is used to limit downward pressure exerted to the face to stabilize the head and neck and to aide in deformity correction. The effects of the traction angle and force on facial contact pressure have not been studied.

Methods. Facial contact pressure was measured for 10 patients undergoing posterior spine surgery in the prone position with Gardner-Wells tongs applied for cervical traction. The facial contact pressure was measured with a force transducer at each of three angles from horizontal (0°, 30°, 45°) and each of four traction weights (0, 5, 10,15 lb), a total of 12 measurement parameters for each patient. An in-line tensiometer provided consistent application of force throughout the traction system.

Results. Ten patients, average age 15 ± 0.6 years, six female, BMI 21.3 ± 1.7, underwent facial pressure monitoring. Post hoc analysis showed that both higher traction weights and angles significantly limited facial pressure (P = 0.0001). The lowest overall average facial pressure of 0.51 lb (95% CI = 0.28–0.73) occurred with 15 lb of traction applied at 45° above the horizontal. This was significantly less facial pressure than found when traction was applied at all weights tested using the commonly employed 0° in-line traction angle (P < 0.0001).

Conclusion. A combination of upward vectored 45° traction angle and 15 lb of weight significantly decreased facial contact pressure. The use of an “in-line tensiometer” assured an accurate force application.

Intraoperative cervical traction during spine surgery serves many functions. Traction, as it relates to facial contact pressure has not been studied. The use of a 45° traction angle and 15 lb of traction weight applied via Gardner-Wells tongs significantly decreases facial contact pressure when compared with standard traction.

* Department of Orthopedic Surgery, Resident UMKC School of Medicine, Kansas City, MO.

Department of Orthopedic Surgery, UMKC School of Medicine/KUMC, Children's Mercy Hospital Kansas City, MO.

Department of Orthopedic Surgery, UMKC School of Medicine/KUMC, Children's Mercy Hospital Kansas City, MO.

Address correspondence and reprint requests to Jason Koreckij MD, 2301 Holmes St, Truman Medical Center, Hospital Hill, Department of Orthopedics, Kansas City, MO 64108; E-mail:

Acknowledgment date: March 25, 2010. First Revision date: August 12, 2010. Acceptance date: September 21, 2010.

The legal regulatory status of the device(s)/drug(s) that is/are the subject of this manuscript is not applicable in my country.

No funds were received in support of this work. No benefits in any form have been or will be received from a commercial party related directly or indirectly to the subject of this manuscript.

© 2011 Lippincott Williams & Wilkins, Inc.