Posterior Ischemic Optic Neuropathy: Case Report of a Rare Complication after General Surgery

A 32-year-old man had fallen from an 8-m high scaffolding and had suffered multiple traumatic injuries, such as compression fractures of the thoracic vertebrae (TV) 5-7 without incarceration of the spinal canal plus a distal femoral fracture. During surgery on the day of the accident, spondylodesis and dorsal stabilization of TV 4-7 using an internal fixator were carried out and the distal femoral fracture was stabilized with a dynamic condylar screw (DCS). On the day following the accident, the malposition of a pedicle screw located at the height of TV 4 and the borderline malposition of a pedicle screw of TV 7 were corrected. Between the day of the accident and day 8 after, the patient developed impaired vision and in the further course amaurosis associated with fixed pupils. No organopathy could be noticed which could have explained the sudden vision loss. A study of the literature was done, using the keywords "blindness" and "spine surgery." Only very few cases describing a connection of spine surgery and postoperative vision loss could be found. This article aims to elaborate on the few connections worked out in these investigations.

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Unerwartete Blindheit nach operativer Versorgung eines polytraumatisierten Patienten

Schmoz

Wawro

Weng

et al. 2006

Unfallchirurg

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Amaurosis after spine surgery: survey of the literature and discussion of one case

et al. 2010

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Postoperative vision loss (POVL) associated with spine surgery is a well known, albeit very rare complication. POVL incidence after spinal surgery ranges from 0.028 to 0.2%; however, due to the increase in number and duration of annual complex spinal operations, the incidence may increase. Origin and pathogenesis of POVL remain frequently unknown. A 73-year-old patient presented with lumbar disc herniation with associated neurological deficits after conservative pre-treatment at a peripheral hospital. Known comorbidities included arterial hypertension, moderate arterial sclerosis, diabetes mellitus type 2, mildly elevated blood lipids and treated prostate gland cancer. During lumbar spine surgery in modified prone position the patient presented with an acute episode of severe hypotension, which required treatment with catecholamines and Trendelenburg positioning. Three hours postoperatively, a visual loss in the right eye occurred, resulting in a complete amaurosis. Antihypertensive medication, arteriosclerosis and intraoperative hypotension are possible causes for the POVL. Intraoperative administration of catecholamines and Trendelenburg positioning for treatment of systemic hypotension might further compromise ocular perfusion. In patients with comorbidities compromising arterial blood pressure, blood circulation and microcirculation, POVL must be considered as a severe postoperative complication. It is recommended to inform patients about such complications and obtain preoperative informed consent regarding POVL. Any recent modification of antihypertensive medication must be reported and analysed for potential intraoperative hemodynamic consequences, prior to spine surgery in prone position.

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Ocular Perfusion Pressure During Pars Plana Vitrectomy: A Pilot Study

Rossi¹,

Querzoli

Angelini³

et al. 2014

Investigative Ophthalmology & Visual Science

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Posterior Ischemic Optic Neuropathy: Case Report of a Rare Complication after General Surgery

Cited by 4 publications

References 9 publications

Unerwartete Blindheit nach operativer Versorgung eines polytraumatisierten Patienten

Unerwartete Blindheit nach operativer Versorgung eines polytraumatisierten Patienten

Amaurosis after spine surgery: survey of the literature and discussion of one case

Ocular Perfusion Pressure During Pars Plana Vitrectomy: A Pilot Study

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