Abducens nerve palsy as a postoperative complication of minimally invasive thoracic spine surgery: a case report

Abstract

BackgroundThoracic 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 PresentationThis 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.ConclusionsIn 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.

Diplopia developed by cervical traction after cervical spine surgery

“…Diplopia is a rare complication after spine surgery, but several cases have been reported [2][3][4][5][6][7][8][9]. In non-spine surgery, diplopia has been reported mainly in patients undergoing spinal anesthesia, and only rarely in patients undergoing general anesthesia [10].…”

“…In the case presented here, the patient did not complain of postoperative diplopia immediately after spine surgery or during anesthetic recovery. Other reports have described times of onset of diplopia varying from 1 day to several days after operation (Table 1) [2][3][4][5][6][7][8][9]. As a result of its delayed onset, postoperative diplopia is rarely diagnosed by the anesthesiologist.…”

“…We presume that the following factors may contribute to delayed onset of diplopia. Intraoperative dural tear, spinal anesthe- sia, and primary intracranial hypotension produce cerebrospinal fluid (CSF) leakage, leading to traction of brain with stretching of CNs, such as the abducens nerve, resulting in subsequent diplopia [4][5][6][7][8][9]11]. Since most patients are usually in the lying position following the operation, the CSF leakage is relatively smaller compared with that in the sitting position; hence, diplopia is relieved [11].…”

“…Since most patients are usually in the lying position following the operation, the CSF leakage is relatively smaller compared with that in the sitting position; hence, diplopia is relieved [11]. However, when the patient sits or stands a few days after operation, the diplopia worsens due to relatively more CSF leakage compared with that in the lying position [4][5][6][7][8]11]. In addition, during the immediate postoperative period, non-attention by the surgeon, depending on the severity of diplopia, may also contribute to delayed onset of diplopia.…”

Palsy of the Contralateral Abducens Nerve after Aneurysm Surgery and Temporal Meningioma in the Presence of Petroclival Meningioma: A Case Report

“…However, palsy of the sixth cranial nerve is also a rare complication following surgeries and procedures that can cause cerebrospinal fluid (CSF) hypotension in areas distant from the nerve pathway. In the literature, there are descriptions of this occurrence mainly in dural lesion spinal surgeries 1,2 and dura mater puncture procedures, 3 such as lumbar punctures and spinal anesthesia.…”