Asian Spine J Search


Asian Spine J > Volume 9(4); 2015 > Article
Ozyurek and Atik: Hypoglossal Nerve Injury after Cervical Spine Surgery
Dear Editor,
We have read with great interest the case report entitled "Hypoglossal nerve palsy as a complication of an anterior approach for cervical spine surgery" in the issue of Asian Spine Journal 2015;9(2):295-298, [1]. We would like to commend the authors for their report on a complex and challenging case.
Hypoglossal nerve injury often follows soft tissue surgery of the neck but is extremely rare following surgery of the upper cervical spine [1,2]. In this article, the authors cited only one report of hypoglossal nerve palsy after anterior cervical spine surgery through the Smith-Robinson approach [1,2]. Nevertheless, we would like to bring to our readers attention an additional case report on hypoglossal nerve injury following anterior surgery to the upper cervical spine. Saunders et al. [3] reported one incidence of hypoglossal palsy as a long-term sequela in a review of 40 cases of central corpectomy for cervical spondylotic myelopathy.
However, we have some concerns regarding the case report and wish to share them with our readers. Hypoglossal nerve injury may be missed unless the deviation of the tongue is noticed carefully. In the cases reported by Saunders et al. [3] and Sengupta et al. [2], the paresis did not recover. Sengupta et al. concluded that together with a review of literature, the hypoglossal nerve should be carefully identified before ligating any large blood vessel in the anterior approach to the upper cervical spine. Spontaneous recovery of hypoglossal palsy may not always be expected.
We also agree with the authors that meticulous tissue dissection and hemostasis should be performed intraoperatively to prevent these adverse events. Relaxing the retractors during surgical procedure will minimize traction injury to neural structures. In addition, the patient should be warned about this complication.
We highly appreciate the authors' contribution to the increase in our knowledge of this difficult clinical problem.

Conflict of Interest

Conflict of Interest: No potential conflict of interest relevant to this article was reported.


1. Yasuda T, Togawa D, Hasegawa T, et al. Hypoglossal nerve palsy as a complication of an anterior approach for cervical spine surgery. Asian Spine J 2015 9:295–298. PMID: 25901245.
crossref pmid pmc
2. Sengupta DK, Grevitt MP, Mehdian SM. Hypoglossal nerve injury as a complication of anterior surgery to the upper cervical spine. Eur Spine J 1999 8:78–80. PMID: 10190859.
crossref pmid pmc
3. Saunders RL, Bernini PM, Shirreffs TG Jr, Reeves AG. Central corpectomy for cervical spondylotic myelopathy: a consecutive series with long-term follow-up evaluation. J Neurosurg 1991 74:163–170. PMID: 1988583.
crossref pmid


Browse all articles >

Editorial Office
Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine
88, Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Korea
Tel: +82-2-3010-3530    Fax: +82-2-3010-8555    E-mail:                
Korean Society of Spine Surgery
27, Dongguk-ro, Ilsandong-gu, Goyang-si 10326, Korea
Tel: +82-31-966-3413    Fax: +82-2-831-3414    E-mail:                

Copyright © 2024 by Korean Society of Spine Surgery.

Developed in M2PI

Close layer
prev next