Yeungnam Univ J Med.  2021 Apr;38(2):152-156. 10.12701/yujm.2020.00241.

Diplopia developed by cervical traction after cervical spine surgery

• Kim JY
• Kim H
• Kang SJ
• Kim H
• Lee YS

• KMID: 2515190
• DOI: http://doi.org/10.12701/yujm.2020.00241

Abstract

Diplopia is a rare complication of spine surgery. The abducens nerve is one of the cranial nerves most commonly related to diplopia caused by traction injury. We report a case of a 71-year-old woman who presented with diplopia developing from abducens nerve palsy after C1–C2 fixation and fusion due to atlantoaxial subluxation with cord compression. As soon as we discovered the symptoms, we suspected excessive traction by the instrument and subsequently performed reoperation. Subsequently, the patient’s symptoms improved. In other reported cases we reviewed, most were transient. However, we thought that our rapid response also helped the patient’s fast recovery in this case. The mechanisms by which postoperative diplopia develops vary and, thus, remain unclear. We should pay attention to the fact that the condition is sometimes an indicator of an underlying, life-threatening condition. Therefore, all patients with postoperative diplopia should undergo thorough ophthalmological and neurological evaluations as well as careful observation by a multidisciplinary team.

Keyword

Abducens nerve; Cranial nerve palsy; Postoperative diplopia; Spine surgery

Figure

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  Fig. 1. Pre- and postoperative cervical spine lateral plain radiography. (A) Preoperative, (B) 1st postoperative, and (C) after 2nd postoperative images. ADI, atlanto-dens interval; BC, distance from the basion to the anterior aspect of the posterior arch of C1; AO, distance from the posterior aspect of the anterior arch of C1 to the opisthion; Powers ratio, BC/AO. In cases of Powers ratio >1 in plain radiographs and ADI >3 mm, anterior atlanto-occipital dissociation should be suspected.

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  Fig. 2. Anatomy and mechanism by which CN6 palsy develops. The CN6 has a very long intracranial course, making this nerve particularly vulnerable to damage. Operative traction, hyperextension (thick arrows), and downward brain placement (thin arrow), can result in stretch injuries where the abducens nerve enters Dorello’s canal. CN3, oculomotor nerve; CN4, trochlear nerve; CN5, trigeminal nerve; CN6 abducens nerve.

Reference

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