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Vectored Cranial-cervical Traction Limits Facial Contact Pressure From Prone Positioning During Posterior Spinal Deformity Surgery.
MedLine Citation:
PMID:  21304423     Owner:  NLM     Status:  Publisher    
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 has 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 degrees) and each of four traction weights (0,5,10,15 pounds), 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 yrs, 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 lbs (95% CI 0.28 -0.73) occurred with 15 lbs of traction applied at 45 degrees above the horizontal. This was significantly less facial pressure than found when traction was applied at all weights tested using the commonly employed 0 degree in-line traction angle (p<0.0001).Conclusion. A combination of upward vectored 45 degree traction angle and 15 lbs of weight significantly decreased facial contact pressure. The use of an "in-line tensiometer" assured an accurate force application.
Jason Koreckij; Nigel Price; Richard M Schwend
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2011-2-7
Journal Detail:
Title:  Spine     Volume:  -     ISSN:  1528-1159     ISO Abbreviation:  -     Publication Date:  2011 Feb 
Date Detail:
Created Date:  2011-2-9     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  7610646     Medline TA:  Spine (Phila Pa 1976)     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
*Resident UMKC School of Medicine, Department of Orthopedic Surgery **Clinical Professor, UMKC School of Medicine/KUMC, Director Spine Deformity Services Children's Mercy Hospital Kansas City, MO - Department of Orthopedic Surgery ***Clinical Professor, UMKC School of Medicine/KUMC, Children's Mercy Hospital Kansas City, MO - Department of Orthopedic Surgery.
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