Hypoglossal nerve injury as a complication of anterior surgery to the upper cervical spine

Injury to the hypoglossal nerve is a recognised complication after soft tis sue surgery in the upper part of the anterior aspect of the neck, e.g. bran chial cyst or carotid body tumour excision. However, this complication has been rarely reported following surgery of the upper cervical spine. We repo rt the case of a 35-year-old woman with tuberculosis of C2-3. She underwent corpectomy and fusion from C2 to C5 using iliac crest bone graft, through. a left anterior oblique incision. She developed hypoglossal nerve palsy in the immediate postoperative period, with dysphagia and dysarthria. It was thought to be due to traction neurapraxia with possible spontaneous recover y. At 18 months' follow-up, she had a solid fusion and tuberculosis was con trolled. The hypoglossal palsy persisted. although with minimal functional disability, The only other reported case of hypoglossal lesion after anteri or cervical spine surgery in the literature also failed to recover. It is c oncluded that hypoglossal nerve palsy following anterior cervical spine sur gery is unlikely to recover spontaneously and it should be carefully identi fied.