Fourth and sixth cranial nerve injury after halo traction in children: a report of two cases.
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.
Pinches
Emma
E
Department of Ophthalmology, Great Ormond Street Hospital for Children, London, United Kingdom.
Thompson
Dominic
D
Noordeen
Hilali
H
Liasis
Alki
A
Nischal
Ken K
KK
D020222:Abducens Nerve Injury / Q000209:etiology*; D000293:Adolescent; D002648:Child; D004172:Diplopia / Q000209:etiology*; D005260:Female; D006801:Humans; D012600:Scoliosis / Q000628:therapy; D013124:Spinal Injuries / Q000000981:diagnostic imaging / Q000628:therapy; D014057:Tomography, X-Ray Computed; D014143:Traction / Q000009:adverse effects*; D020432:Trochlear Nerve Diseases / Q000209:etiology*; D061247:Trochlear Nerve Injuries