Abducens Nerve Palsy As a Postoperative Complication of Minimally Invasive Thoracic Spine Surgery: a Case Report

Overview

Journal BMC Surg

Publisher Biomed Central

Specialty General Surgery

Date 2016 Jul 15

PMID 27411912

Citations 7

Authors

Luiz Henrique Dias Sandon

Gun Choi

Eunsoo Park

Hyung-Chang Lee

Affiliations

Soon will be listed here.

Abstract

Background: Thoracic disc surgeries make up only a small number of all spine surgeries performed, but they can have a considerable number of postoperative complications. Numerous approaches have been developed and studied in an attempt to reduce the morbidity associated with the procedure; however, we still encounter cases that develop serious and unexpected outcomes.

Case Presentation: This case report presents a patient with abducens nerve palsy after minimally invasive surgery for thoracic disc herniation with an intraoperative spinal fluid fistula. A literature review of all cases related to this complication after spine surgery is included. Despite the uncommon nature of this type of complication, understanding the procedure itself, the principle occurrences and outcomes following the procedure, the physiopathogical features of abducens nerve palsy, and the possible adverse effects of spinal surgery, including minimally invasive procedures, can enable an early diagnosis of complications and facilitate the procedure.

Conclusions: In spite of being very rare and multifactorial, uni- or bilateral abducens nerve paralysis carries significant morbidity and can occur as a postoperative complication after conventional or minimally invasive spine surgery. This condition requires an accurate diagnosis and adequate multidisciplinary follow up.

Citing Articles

Acute Cranial Nerve VI Palsy Following Prolonged Prone Positioning in an Adolescent With Neurofibromatosis Type 1: A Rare Complication of Spinal Surgery in the Prone Position.

Mpody C, Olbrecht V, Tobias J J Med Cases. 2023; 14(9-10):317-321.

PMID: 37868328 PMC: 10586333. DOI: 10.14740/jmc4145.

Abducens nerve palsy associated with pseudomeningocele after cervical spine surgery: a case report.

Hernandez-Mateo J, Riquelme-Garcia O, Igualada-Blazquez C, Solans-Lopez M, Esparragoza-Cabrera L J Spine Surg. 2023; 9(1):109-113.

PMID: 37038420 PMC: 10082435. DOI: 10.21037/jss-22-92.

Clinical Consequences of Incidental Durotomy during Full-Endoscopic Lumbar Decompression Surgery in Relation to Intraoperative Epidural Pressure Measurements.

Vargas R, Moscatelli M, de Lima M, Leon J, Lorio M, Fiorelli R J Pers Med. 2023; 13(3).

PMID: 36983563 PMC: 10052087. DOI: 10.3390/jpm13030381.

Transient internuclear ophthalmoplegia following anterior cervical discectomy and fusion.

Cordeiro K, Greeneway G, Page P, Brooks N Surg Neurol Int. 2022; 13:527.

PMID: 36447899 PMC: 9699831. DOI: 10.25259/SNI_984_2022.

Diplopia developed by cervical traction after cervical spine surgery.

Kim J, Kim H, Kang S, Kim H, Lee Y Yeungnam Univ J Med. 2020; 38(2):152-156.

PMID: 32723983 PMC: 8016621. DOI: 10.12701/yujm.2020.00241.

References

Russo A, Balamurali G, Nowicki R, Boszczyk B . Anterior thoracic foraminotomy through mini-thoracotomy for the treatment of giant thoracic disc herniations. Eur Spine J. 2012; 21 Suppl 2:S212-20. PMC: 3326080. DOI: 10.1007/s00586-012-2263-6. View

Logue V . Thoracic intervertebral disc prolapse with spinal cord compression. J Neurol Neurosurg Psychiatry. 1952; 15(4):227-41. PMC: 499566. DOI: 10.1136/jnnp.15.4.227. View

Uribe J, Dakwar E, Le T, Christian G, Serrano S, Smith W . Minimally invasive surgery treatment for thoracic spine tumor removal: a mini-open, lateral approach. Spine (Phila Pa 1976). 2010; 35(26 Suppl):S347-54. DOI: 10.1097/BRS.0b013e3182022d0f. View

Berjano P, Garbossa D, Damilano M, Pejrona M, Bassani R, Doria C . Transthoracic lateral retropleural minimally invasive microdiscectomy for T9-T10 disc herniation. Eur Spine J. 2014; 23(6):1376-8. DOI: 10.1007/s00586-014-3369-9. View

Joo J, Yoon S, Kim K, Jahng T, Kim H . Isolated abducens nerve palsy due to cerebrospinal fluid leakage following lumbar discectomy: a rare clinical entity. Eur Spine J. 2012; 22 Suppl 3:S421-3. PMC: 3641264. DOI: 10.1007/s00586-012-2545-z. View

Nakagawa H, Kamimura M, Uchiyama S, Takahara K, Itsubo T, Miyasaka T . Abducens nerve palsy as a rare complication of spinal surgery: a case report. J Orthop Sci. 2003; 8(6):869-71. DOI: 10.1007/s00776-003-0711-1. View

Khurana A, Brousil J, Russo A, Evans A, Quraishi N, Boszczyk B . Intracranial hypotension with a sixth cranial nerve palsy subsequent to massive thoracic CSF hygroma: a rare complication of thoracic disc excision. Eur Spine J. 2013; 22(9):2047-54. PMC: 3777070. DOI: 10.1007/s00586-013-2818-1. View

Cho D, Jung E, Chi Y . Abducens nerve palsy after lumbar spinal fusion surgery with inadvertent dural tearing. J Korean Neurosurg Soc. 2010; 46(6):581-3. PMC: 2803277. DOI: 10.3340/jkns.2009.46.6.581. View

Uribe J, Dakwar E, Cardona R, Vale F . Minimally invasive lateral retropleural thoracolumbar approach: cadaveric feasibility study and report of 4 clinical cases. Neurosurgery. 2011; 68(1 Suppl Operative):32-9. DOI: 10.1227/NEU.0b013e318207b6cb. View

10.

Holmes G . Observations on OCULAR PALSIES. Br Med J. 2010; 2(3703):1165-7. PMC: 2315491. DOI: 10.1136/bmj.2.3703.1165. View

11.

Rosenthal D, Dickman C . Thoracoscopic microsurgical excision of herniated thoracic discs. J Neurosurg. 1998; 89(2):224-35. DOI: 10.3171/jns.1998.89.2.0224. View

12.

Thomas A, Shetty A, Rajasekaran S . Abducens nerve palsy associated with pseudomeningocele after lumbar disc surgery: a case report. Spine (Phila Pa 1976). 2011; 37(8):E511-3. DOI: 10.1097/BRS.0b013e3182373b95. View

13.

Barsoum W, Mayerson J, Bell G . Cranial nerve palsy as a complication of operative traction. Spine (Phila Pa 1976). 1999; 24(6):585-6. DOI: 10.1097/00007632-199903150-00019. View

14.

Zada G, Solomon T, Giannotta S . A review of ocular manifestations in intracranial hypotension. Neurosurg Focus. 2007; 23(5):E8. DOI: 10.3171/FOC-07/11/E8. View

15.

Azarmina M, Azarmina H . The six syndromes of the sixth cranial nerve. J Ophthalmic Vis Res. 2013; 8(2):160-71. PMC: 3740468. View

16.

Yoshihara H, Yoneoka D . Comparison of in-hospital morbidity and mortality rates between anterior and nonanterior approach procedures for thoracic disc herniation. Spine (Phila Pa 1976). 2014; 39(12):E728-33. DOI: 10.1097/BRS.0000000000000322. View