Hypoglossal nerve injury with C1 lateral mass screw placement: A case report and review of the literature

Maria De Abreu Pineda, BS; Elias Atallah, MD; John Wainwright, MD; Joseph Schaefer, MD; Aria Mahtabfar, MD; James Harrop, MD; Srinivas Prasad, MD; Joshua Heller, MD; Ashwini Sharan, MD; Ahilan Sivaganesan, MD; Jack Jallo, MD

Radiology Case Reports (Dec 2022)

Hypoglossal nerve injury with C1 lateral mass screw placement: A case report and review of the literature

Maria De Abreu Pineda, BS,
Elias Atallah, MD,
John Wainwright, MD,
Joseph Schaefer, MD,
Aria Mahtabfar, MD,
James Harrop, MD,
Srinivas Prasad, MD,
Joshua Heller, MD,
Ashwini Sharan, MD,
Ahilan Sivaganesan, MD,
Jack Jallo, MD

Affiliations

Maria De Abreu Pineda, BS: Sidney Kimmel Medical College at Thomas Jefferson University, 1025 Walnut St #100, Philadelphia, PA 19107, USA; Corresponding author.
Elias Atallah, MD: Thomas Jefferson University Hospital, Department of Neurological Surgery, 111 S 11th St, Philadelphia, PA 19107, USA
John Wainwright, MD: Thomas Jefferson University Hospital, Department of Neurological Surgery, 111 S 11th St, Philadelphia, PA 19107, USA
Joseph Schaefer, MD: Thomas Jefferson University Hospital, Department of Neurological Surgery, 111 S 11th St, Philadelphia, PA 19107, USA
Aria Mahtabfar, MD: Thomas Jefferson University Hospital, Department of Neurological Surgery, 111 S 11th St, Philadelphia, PA 19107, USA
James Harrop, MD: Thomas Jefferson University Hospital, Department of Neurological Surgery, 111 S 11th St, Philadelphia, PA 19107, USA
Srinivas Prasad, MD: Thomas Jefferson University Hospital, Department of Neurological Surgery, 111 S 11th St, Philadelphia, PA 19107, USA
Joshua Heller, MD: Thomas Jefferson University Hospital, Department of Neurological Surgery, 111 S 11th St, Philadelphia, PA 19107, USA
Ashwini Sharan, MD: Thomas Jefferson University Hospital, Department of Neurological Surgery, 111 S 11th St, Philadelphia, PA 19107, USA
Ahilan Sivaganesan, MD: Thomas Jefferson University Hospital, Department of Neurological Surgery, 111 S 11th St, Philadelphia, PA 19107, USA
Jack Jallo, MD: Thomas Jefferson University Hospital, Department of Neurological Surgery, 111 S 11th St, Philadelphia, PA 19107, USA

Journal volume & issue: Vol. 17, no. 12
pp. 4594 – 4598

Abstract

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We report the case of a 62-year-old man who presented with a progressive myelopathy secondary to spinal cord compression from an odontoid process fracture and subaxial central canal stenosis. The patient underwent a C1-T2 posterior decompression and instrumented fusion (PCDF) and did well immediately postoperatively. However, on POD1, he developed a right hypoglossal nerve (HN) palsy attributed to direct mechanical compression or injury from the C1 lateral mass screw (LMS), which improved following a revision and screw replacement. While HN injury is a known complication of high anterior and anterolateral cervical spine approaches as well as transcondylar screw fixation, this case aims to expand on the limited reports available regarding hypoglossal nerve injury following placement of bicortical C1 LMS. Furthermore, the use of fluoroscopic guidance in addition to anatomic landmarks and triggered electromyography of the tongue are offered as potential solutions to prevent HN injury intraoperatively.

Published in Radiology Case Reports

ISSN: 1930-0433 (Online)
Publisher: Elsevier
Country of publisher: United States
LCC subjects: Medicine: Medicine (General): Medical physics. Medical radiology. Nuclear medicine
Website: https://www.sciencedirect.com/journal/radiology-case-reports

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