Gardner-Wells Tongs Are a Safe Alternative for Intraoperative Positioning and Spine Surgery

Gardner-Wells tongs (GWT) are commonly used in cervical spine trauma for closed and open treatment of the cervical spine and for patient positioning and reduction, aiding in fracture reduction and providing temporary stabilization. Tongs are less commonly used for nontraumatic spine surgery, and a paucity of literature exists assessing the rates of complications associated with the use of GWT. The purpose of this study was to elucidate the incidence of major and minor complications associated with the use of GWT in traumatic and nontraumatic spine surgeries performed by a single surgeon at a single tertiary care academic institution.

Adult patients who underwent traumatic or nontraumatic spinal surgery at any spine level with the use of GWT from a single surgeon between 2020 and 2023 met inclusion criteria for this retrospective case series. Major complications were defined as medial table breech, deep infection/abscess, pin pullout, neurovascular injury, and vision disturbances (ie, increased intraocular pressure) at any time point. Minor complications were defined as pin loosening, minor bleeding requiring staples, and superficial infection at any time point.

Data from 322 patients, including 171 (53.1%) men and 151 (46.9%) women, were reviewed and analyzed. Mean patient age at the time of surgery was 57 years (range 18 to 89). Mean operative time was 165 minutes, and average traction weight applied was 14.7 pounds. Incidence of major complications was 0.3% and included just one instance of visual disturbance 6 weeks postoperatively that spontaneously resolved. Incidence of minor complications was 4.66% (15/322) and involved 14 cases (4.35%) of minor bleeding managed with staples and one occurrence of pin loosening.

The use of GWT in a variety of traumatic and nontraumatic spine surgeries was found to be safe and effective in this single-surgeon, single-institution study cohort. Only one patient developed a major complication, and the incidence of minor complications was less than 5%. [Orthopedics. 2025;48(3):153-158.].