- Department of Neurological Surgery, University of Wisconsin, School of Medicine and Public Health, Madison, Wisconsin, United States.
Correspondence Address:
Paul S. Page, Department of Neurological Surgery, University of Wisconsin, School of Medicine and Public Health, Madison, Wisconsin, United States.
DOI:10.25259/SNI_984_2022
Copyright: © 2022 Surgical Neurology International This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-Share Alike 4.0 License, which allows others to remix, transform, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.How to cite this article: Kevin N. Cordeiro, Garret P. Greeneway, Paul S. Page, Nathaniel P. Brooks. Transient internuclear ophthalmoplegia following anterior cervical discectomy and fusion. 11-Nov-2022;13:527
How to cite this URL: Kevin N. Cordeiro, Garret P. Greeneway, Paul S. Page, Nathaniel P. Brooks. Transient internuclear ophthalmoplegia following anterior cervical discectomy and fusion. 11-Nov-2022;13:527. Available from: https://surgicalneurologyint.com/surgicalint-articles/11989/
Abstract
Background: Internuclear ophthalmoplegia (INO), characterized by impaired horizontal eye movement, occurred following an anterior cervical discectomy/fusions (ACDF).
Case Description: A 48-year-old female with recurrent C5-6 foraminal stenosis presented with right C6 radiculopathy. She underwent a C5-6 ACDF, but postoperatively, complained of diplopia. Her examination revealed left-eye INO. Notably, the brain magnetic resonance imaging showed no significant radiological findings. The patient’s diplopia and INO resolved spontaneously on postoperative day 2 and never recurred.
Conclusion: Ocular complications following anterior cervical spine procedures are rare. Here, a 48-year-old female developed left eye INO following an ACDF that spontaneously resolved on postoperative day 2.
Keywords: Anterior cervical discectomy and fusion, internuclear ophthalmoplegia, Medial longitudinal fasciculus, INO
INTRODUCTION
Ocular/visual complications following anterior cervical discectomy/fusions (ACDF) are rare. Gabel et al., in a retrospective and multi-center study of over 17,000 cervical spine surgeries, found no cases of postoperative blindness or vision loss.[
CASE DESCRIPTION
A 48-year-old female following a prior C5-6 posterior cervical endoscopic foraminotomy presented with recurrent right arm pain and diminished sensation in the right C6 dermatome, plus a positive Spurling maneuver. Cervical magnetic resonance imaging (MRI) demonstrated persistent right C5-6 foraminal stenosis and lateral disc protrusion [
DISCUSSION
Ocular complications following cervical spine surgery are exceedingly rare. There are only a handful of cases in the literature describing diplopia in patients following spine surgery, let alone cervical spine surgery [
CONCLUSION
Here, we present a 48-year-old female who developed transient 1–2-day onset of a left-eye INO following a routine C5-C6 ACDF.
Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
Disclaimer
The views and opinions expressed in this article are those of the authors and do not necessarily reflect the official policy or position of the Journal or its management. The information contained in this article should not be considered to be medical advice; patients should consult their own physicians for advice as to their specific medical needs.
References
1. Abd-Elsayed AA, Barsoum W, Bell G, Guirguis M, Farag E. Diplopia following spine surgery: A case series. Open Neurosurg J. 2011. 4: 14-5
2. Barsoum WK, Mayerson J, Bell GR. Cranial nerve palsy as a complication of operative traction. Spine (Phila Pa 1976). 1999. 24: 585-6
3. Cho DC, Jung ES, Chi YC. Abducens nerve palsy after lumbar spinal fusion surgery with inadvertent dural tearing. J Korean Neurosurg Soc. 2009. 46: 581-3
4. Gabel BC, Lam A, Chapman JR, Oskouian RJ, Nassr A, Currier BL. Perioperative vision loss in cervical spinal surgery. Global Spine J. 2017. 7: 91S-5
5. Joo JD, Yoon SH, Kim KJ, Jahng TA, Kim HJ. Isolated abducens nerve palsy due to cerebrospinal fluid leakage following lumbar discectomy: A rare clinical entity. Eur Spine J. 2013. 22: S421-3
6. Khurana A, Brousil J, Russo A, Evans A, Quraishi NA, Boszczyk BM. 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: 2047-54
7. Kim JY, Kim H, Kang SJ, Kim H, Lee YS. Diplopia developed by cervical traction after cervical spine surgery. Yeungnam Univ J Med. 2021. 38: 152-6
8. 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: 869-71
9. Sandon LHD, Choi G, Park E, Lee HC. Abducens nerve palsy as a postoperative complication of minimally invasive thoracic spine surgery: A case report. BMC Surg. 2016. 16: 47
10. Thomas A, Shetty AP, Rajasekaran S. Abducens nerve palsy associated with pseudomeningocele after lumbar disc surgery: A case report. Spine (Phila Pa 1976). 2012. 37: E511-3