Hypoglossal nerve injury caused by halo-suspension traction. A case report.
METHODS
A case report of injury to the hypoglossal nerve (CN XII) resulting from the use of halogravity traction in a child with severe cervicothoracic kyphosis after an anterior and posterior spinal release.


OBJECTIVE
To describe one of the potential dangers of halo-suspension (gravity) traction, which has not been reported previously in the orthopedic literature.


BACKGROUND
Cranial nerve injuries resulting from halo-skeletal traction are a recognized complication of such treatment, especially in patients with myelomeningocele. Halo-suspension traction using the patient's body weight as counter-traction has been recommended to provide a less rigid force and to reduce complications.


METHODS
The authors report on the mechanism of injury and clinical course in a 12-year-old boy with myelomeningocele and a bilateral CN XII injury caused by halo-suspension traction from onset to resolution.


RESULTS
This patient had dysphagia and difficulty swallowing 5 days after surgery. His wheelchair traction at this point was approximately 40% of his body weight. The traction was reduced, and a corticosteroid was administered. The patient's symptoms began to abate 5 days later. At 6 weeks after injury, his cranial nerve function was normal.


CONCLUSIONS
Although halo-suspension traction or halo-wheelchair traction may be less rigid, injury to the hypoglossal nerve can be produced with traction exceeding 40% of body weight. In the patient in the current report, resolution of this injury was complete within 5 weeks, an outcome that is consistent with those of other reported cases of CN XII injury.
Ginsburg
G M
GM
Department of Orthopaedics, University of Nebraska, Omaha, USA.
Bassett
G S
GS
D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D002648:Child; D003680:Deglutition Disorders / Q000209:etiology; D006801:Humans; D061228:Hypoglossal Nerve Injuries; D007738:Kyphosis / Q000628:therapy*; D008297:Male; D008591:Meningomyelocele / Q000150:complications; D009333:Neck; D010243:Paralysis / Q000209:etiology / Q000628:therapy; D013123:Spinal Fusion; D013909:Thorax; D014143:Traction / Q000009:adverse effects* / Q000295:instrumentation; D014910:Wheelchairs
D000305:Adrenal Cortex Hormones