Fourth and sixth cranial nerve injury after halo traction in children: a report of two cases.

Abstract

BACKGROUND:

Spinal traction is the application of a longitudinal force to the spinal column as a means of stabilizing a damaged or abnormal spine. Although not well documented in the ophthalmic literature, complications include cranial nerve palsies, with the sixth nerve being most commonly affected. Fourth nerve palsies have not previously been reported to our knowledge. We present 2 cases of combined fourth and sixth palsies after cervical traction.

METHODS:

Retrospectively, we reviewed the ophthalmic findings in 2 children with diplopia after spinal traction.

RESULTS:

Case 1 suffered a traumatic rotatory atlantoaxial subluxation and underwent halo traction. Case 2 required traction to correct a scoliosis secondary to osteogenesis imperfecta. In both cases, sixth nerve palsies were apparent soon after traction. Careful orthoptic examination revealed additional fourth nerve involvement. After 3 months, both cases showed partial resolution of the cranial nerve injuries.

CONCLUSIONS:

Cranial nerve injury may occur with spinal traction. Fourth nerve palsy may be underreported because of masking by a coinciding sixth nerve palsy.

• Authors: Emma Pinches, Dominic Thompson, Hilali Noordeen, Alki Liasis, Ken K Nischal
• Journal: Journal of AAPOS : the official publication of the American Association for Pediatric Ophthalmology and Strabismus (J AAPOS) Vol. 8 Issue 6 Pg. 580-5 (Dec 2004) ISSN: 1091-8531 [Print] United States
• PMID: 15616508 (Publication Type: Case Reports, Journal Article)

Topics

• Abducens Nerve Injury (etiology)
• Adolescent
• Child
• Diplopia (etiology)
• Female
• Humans
• Scoliosis (therapy)
• Spinal Injuries (diagnostic imaging, therapy)
• Tomography, X-Ray Computed
• Traction (adverse effects)
• Trochlear Nerve Diseases (etiology)
• Trochlear Nerve Injuries