Bridging the gap: Gardner-Wells tongs utilization in pediatric spinal tuberculosis: A case report.

Introduction: Spinal Tuberculosis (TB), or Pott's disease, is a significant form of extrapulmonary TB affecting the spine, especially in children. Standard treatments include anti-tuberculosis medications, immobilization, and surgery. The use of Gardner well tongs (GWT) in pediatrics spinal TB is rare due to associated risks and lack of supporting evidence. This case report aims to document the application of GWT traction in conjunction with surgical intervention for a pediatric patient with tuberculosis spondylitis.

Case Presentation: An 8-year-old boy presented with progressive weakness in both legs over 2.5 years, culminating in his inability to stand or walk. Physical examination revealed asymmetrical back, gibbus formation, tenderness, limited range of motion, and upper motor neuron neurological deficits. Radiographic imaging showed vertebral body destruction from T1-6, causing an 81-degree kyphotic curve. The patient underwent 5 kg of GWT traction for 2 weeks, resulting in a 10-degree improvement in curvature. Subsequent surgical procedures included laminectomy, posterior stabilization, deformity correction, and post-operative application of a SOMI brace. By discharge, the patient's kyphotic angle had improved from 81 to 63°, and there was notable improvement in motor strength and neurological function.

Discussion: While surgical intervention is often necessary for vertebral deformity restoration, GWT offers advantages in spinal TB management, such as achieving stable cervical segments without skin incision and aiding gradual kyphotic correction. Serious complications from GWT, like skull perforation or neurovascular damage, are infrequent.

Conclusion: A comprehensive, holistic approach incorporating GWT traction and surgical intervention is essential for improving clinical outcomes in pediatric tuberculosis spondylitis.