title: Abducens nerve palsy as a postoperative complication of minimally invasive thoracic spine surgery: a case report.
abstract: BACKGROUND
  Thoracic 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.
  
  
  METHODS
  This 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.
  
  
  CONCLUSIONS
  In 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.
authors.affiliation: Neurosurgery Resident at Hospital das Clinicas de São Paulo, São Paulo, Brazil. lhdsandon@yahoo.com.br.|International Spine Surgery Fellow, Pohang Wooridul Hospital, Pohang, South Korea. lhdsandon@yahoo.com.br.|Department of Neurosurgery, Hospital da Clinicas FMUSP, Rua Oscar Freire, 1811, ap 113, Cerqueira Cesar, Sao Paulo, Brazil. lhdsandon@yahoo.com.br.
authors.forename: Luiz Henrique Dias
authors.initials: LH
authors.lastname: Sandon
authors.affiliation: Neurosurgeon/Spine Surgeon and Medical Director, Pohang Wooridul Hospital, Pohang, South Korea.
authors.forename: Gun
authors.initials: G
authors.lastname: Choi
authors.affiliation: Neurosurgeon/Spine Surgeon and Consultant, Pohang Wooridul Hospital, Pohang, South Korea.
authors.forename: EunSoo
authors.initials: E
authors.lastname: Park
authors.affiliation: Thoracic Surgeon/Consultant at Busan Wooridul Hospital, Busan, South Korea.
authors.forename: Hyung-Chang
authors.initials: HC
authors.lastname: Lee
mesh_terms: D020434:Abducens Nerve Diseases / Q000209:etiology*; D017586:Diskectomy / Q000009:adverse effects*; D005260:Female; D006801:Humans; D007405:Intervertebral Disc Displacement / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000009:adverse effects; D011183:Postoperative Complications / Q000209:etiology*; D013117:Spinal Cord Compression / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery*; D013904:Thoracic Vertebrae
keywords: Cerebrospinal fluid leakage; Cranial nerve palsy; Intracranial hypotension; Minimally invasive; Thoracic disc herniation