Diplopia Following Spine Surgery: A Case Series

Introduction: Cranial traction leading to 6th nerve palsy is the main cause of developing diplopia following spinal surgery. Very few cases of abducens nerve palsy as a complication of surgery without cranial traction have been described. We review a series of four patients who developed diplopia following spinal surgery only one of which had cranial pins or apparent traction on the abducens nerve. Case presentations: Case 1, a 14-year-old girl who had a posterior segmental instrumentation correction and fusion under general anesthesia in the prone position. Case 2, a 34 year old woman who had posterior fusion and fixation. Case 3, a 67 year-old woman who had a C5-C6, C6-C7 anterior cervical diskectomy and fusion procedure. Cranial traction was utilized. Case 4, an 18 year-old woman who had an anterior interbody spinal fusion. All cases developed facial edema and diplopia on the first day postoperatively. Conclusion: Diplopia is a rare complication following spine surgery. It needs special attention as it can be attributed to several reasons. Facial edema, face traction and CSF leakage were the possible reasons in our cases. Diplopia was temporary and resolved spontaneously in all our cases.