Ischemic Orbital Compartment Syndrome After Posterior Spinal Surgery

Yu, Yi‐Hsun; Chen, Wen-Jer; Chen, Lih-Huei; Chen, Wen-Chien

doi:10.1097/brs.0b013e31817c55c2

Cited by 23 publications

(21 citation statements)

References 21 publications

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“…3,21,22,31 Ischemic optic neuropathy (ION) and orbital compartment syndrome (OCS) Direct pressure on orbits can cause trauma resulting in conjunctival edema, hemorrhage, chemosis, pain, and vision loss. 7,14 ION is caused by damage to optic nerve by increased intraocular pressure and orbital venous pressure. 32 ION can be classified as either anterior ION, anterior to lamina cribrosa, or posterior ION.…”

Section: Postoperative Vision Loss (Povl) and Other Ophthalmic Injuriesmentioning

confidence: 99%

“…Raised intraocular pressure in combination with raised intra-abdominal pressure reduces venous return in the orbit increasing venous pressure and edema. 14,22,35 Edema can be aggravated by high-volume fluid replacement aggravating intraocular pressure.…”

Section: Postoperative Vision Loss (Povl) and Other Ophthalmic Injuriesmentioning

confidence: 99%

“…7,14,16,35À37,46,47 The reverse Trendelenburg position at 108 has been suggested to ameliorate raised intraocular pressure in prone position. 13,14,31,36,40,43,48 However, in surgeries involving the head or neck, this reverse Trendelenburg position should not be overdone, as this will increase the risk of venous air embolism. 49 If the Trendelenburg position is required during surgery, minimize time with the head below heart level.…”

Section: Recommendationsmentioning

confidence: 99%

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The Prone Position During Surgery and its Complications: A Systematic Review and Evidence-Based Guidelines

Kwee

Rozen

2015

International Surgery

186

143

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Surgery in the prone position is often a necessity when access to posterior anatomic structures is required. However, many complications are known to be associated with this type of surgery, as physiologic changes occur with increased pressure to anterior structures. While several studies have discussed postoperative vision loss, much fewer studies with lower levels of evidence have addressed other complications. A systematic literature review was conducted using 2 different databases, and 53 papers were regarded as appropriate for inclusion. Qualitative and quantitative analysis was performed. Thirteen complications were identified. Postoperative vision loss and cardiovascular complications, including hypovolemia and cardiac arrest, had the most number of studies and highest level of evidence. Careful planning for optimal positioning, padding, timing, as well as increased vigilance are evidence-based recommendations where operative prone positioning is required.

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Section: Postoperative Vision Loss (Povl) and Other Ophthalmic Injuriesmentioning

confidence: 99%

Section: Postoperative Vision Loss (Povl) and Other Ophthalmic Injuriesmentioning

confidence: 99%

Section: Recommendationsmentioning

confidence: 99%

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The Prone Position During Surgery and its Complications: A Systematic Review and Evidence-Based Guidelines

Kwee

Rozen

2015

International Surgery

186

143

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“…Twentyfour studies performed surgery in the prone position (Table 1), and 7 studies investigated complications following lumbar spine surgery in the knee-chest position (Table 2). 1,2,[5][6][7][9][10][11]13,15,18,19,[21][22][23][24][25][26]28,29,[32][33][34]36,37,39,40,42,[46][47][48] Complications related to the knee-elbow, lateral decubitus, and supine positions were each reported by a single study (Table 3). 14,30,31 prone-position studies Vision loss was the most commonly reported complication, with 11 case reports describing postoperative-onset vision loss.…”

Section: Study Characteristicsmentioning

confidence: 99%

“…Onset of vision loss can occur early during the postoperative period and may present with decreased visual acuity, lack of light perception, ophthalmoplegia, and/ or ptosis. 47 These symptoms arise following ischemic optic neuropathy, central artery occlusion, ischemic orbital compartment syndrome, or occipital cerebral infarction. These findings can occur unilaterally or bilaterally.…”

Section: Vision Lossmentioning

confidence: 99%

Lumbar spine surgery positioning complications: a systematic review

Shriver

Zeer

Alentado

et al. 2015

FOC

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OBJECT There are a variety of surgical positions that provide optimal exposure of the dorsal lumbar spine. These include the prone, kneeling, knee-chest, knee-elbow, and lateral decubitus positions. All are positions that facilitate exposure of the spine. Each position, however, is associated with an array of unique complications that result from excessive pressure applied to the torso or extremities. The authors reviewed clinical studies reporting complications that arose from positioning of the patient during dorsal exposures of the lumbar spine. METHODS MEDLINE, Scopus, and Web of Science database searches were performed to find clinical studies reporting complications associated with positioning during lumbar spine surgery. For articles meeting inclusion criteria, the following information was obtained: publication year, study design, sample size, age, operative time, type of surgery, surgical position, frame or table type, complications associated with positioning, time to first observed complication, long-term outcomes, and evidence-based recommendations for complication avoidance. RESULTS Of 3898 articles retrieved from MEDLINE, Scopus, and Web of Science, 34 met inclusion criteria. Twenty-four studies reported complications associated with use of the prone position, and 7 studies investigated complications after knee-chest positioning. Complications associated with the knee-elbow, lateral decubitus, and supine positions were each reported by a single study. Vision loss was the most commonly reported complication for both prone and knee-chest positioning. Several other complications were reported, including conjunctival swelling, Ischemic orbital compartment syndrome, nerve palsies, thromboembolic complications, pressure sores, lower extremity compartment syndrome, and shoulder dislocation, highlighting the assortment of possible complications following different surgical positions. For prone-position studies, there was a relationship between increased operation time and position complications. Only 3 prone-position studies reported complications following procedures of less than 120 minutes, 7 studies reported complications following mean operative times of 121–240 minutes, and 9 additional studies reported complications following mean operative times greater than 240 minutes. This relationship was not observed for knee-chest and other surgical positions. CONCLUSIONS This work presents a systematic review of positioning-related complications following prone, knee-chest, and other positions used for lumbar spine surgery. Numerous evidence-based recommendations for avoidance of these potentially severe complications associated with intraoperative positioning are discussed. This investigation may serve as a framework to educate the surgical team and decrease rates of intraoperative positioning complications.

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Pathogenesis of Classical Non-arteritic Anterior Ischemic Optic Neuropathy

Hayreh

2011

Ischemic Optic Neuropathies

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Ischemic Orbital Compartment Syndrome After Posterior Spinal Surgery

Abstract: Understanding ocular complications after spinal surgery is vital. Although rare, but the most troublesome complication is ischemic orbital compartment syndrome.

Cited by 23 publications

References 21 publications

The Prone Position During Surgery and its Complications: A Systematic Review and Evidence-Based Guidelines

The Prone Position During Surgery and its Complications: A Systematic Review and Evidence-Based Guidelines

Lumbar spine surgery positioning complications: a systematic review

Pathogenesis of Classical Non-arteritic Anterior Ischemic Optic Neuropathy

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