Bilateral Hypoglossal Nerve Palsy After Occipitocervical Fusion

Abstract

A 63-year-old man sustained a Jefferson fracture and was treated nonoperatively by a separate treating surgeon. Because of the symptomatic malalignment and nonunion after 6 months of nonsurgical management, the patient was seen for a second opinion. Occiput to C3 arthrodesis was performed. Postoperatively, the patient was diagnosed with a bilateral hypoglossal nerve palsy. Hypoglossal nerve injuries after cervical spine fractures and posterior cervical procedures are a very rare occurrence. This is the first case report of a bilateral hypoglossal nerve palsy following occipitocervical arthrodesis.

Hypoglossal nerve palsy following spine surgery in Klippel-Feil syndrome patient

“…Previous cases describe similar complications following various cervical spine operations at different levels from both anterior3,4,9,10 and posterior1,5,11,12 approaches. Symptoms typically present unilaterally, but a case of bilateral hypoglossal nerve palsy has been reported following occiput to C3 arthrodesis 12. Common symptoms include dysarthria, dysphagia, and tongue weakness which may be persist indefinitely4,10 or improve over time 1,3,11,12.…”

“…Given the rarity of hypoglossal nerve palsy following cervical spine surgery, the number of reported cases is limited. Previous cases describe similar complications following various cervical spine operations at different levels from both anterior3,4,9,10 and posterior1,5,11,12 approaches. Symptoms typically present unilaterally, but a case of bilateral hypoglossal nerve palsy has been reported following occiput to C3 arthrodesis 12.…”

“…Symptoms typically present unilaterally, but a case of bilateral hypoglossal nerve palsy has been reported following occiput to C3 arthrodesis. 12 Common symptoms include dysarthria, dysphagia, and tongue weakness which may be persist indefinitely 4,10 or improve over time. 1,3,11,12 The most generally suspected causes include nerve compression due to orotracheal intubation 5 or retraction of the internal carotid artery during surgery.…”

“…12 Common symptoms include dysarthria, dysphagia, and tongue weakness which may be persist indefinitely 4,10 or improve over time. 1,3,11,12 The most generally suspected causes include nerve compression due to orotracheal intubation 5 or retraction of the internal carotid artery during surgery. 3,4 Previous reports indicate that KFS may be associated with non-orthopedic anatomical abnormalities such as persistent trigeminal artery 7 and variations in vertebral artery location.…”