HYPOGLOSSAL NERVE INJURY CAUSED BY HALO-SUSPENSION TRACTION - A CASE-REPORT

Study Design. A case report of injury to the hypoglossal nerve (CN XII ) resulting from the use of halogravity traction in a child with sever e cervicothoracic kyphosis after an anterior and posterior spinal rele ase. Objective. To describe one of the potential dangers of halo-suspe nsion (gravity) traction, which has not been reported previously in th e orthopedic literature. Summary of Background Data. Cranial nerve inj uries resulting from halo-skeletal traction are a recognized complicat ion of such treatment, especially in patients with myelomeningocele. H alo-suspension traction using the patient's body weight as counter-tra ction 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 swal lowing 5 days after surgery. His wheelchair traction at this point was approximately 40% of his bodyweight. 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-wheelc hair traction may be less rigid, injury to the hypoglossal nerve can b e 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 cas es of CN XII injury.