Unilateral Blindness as a Complication of Intraoperative Positioning for Cervical Spinal Surgery

Manfredini, Massimiliano; Ferrante, Rossella; Gildone, Alessandro; Massari, Leo

doi:10.1097/00002517-200006000-00013

Cited by 24 publications

(12 citation statements)

References 6 publications

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“…[2][3][4][5][6][7][8][9][10][11][12][13] With the exception of proximal embolism from the ipsilateral internal carotid artery in cardiac surgery patients, the most common etiology of perioperative CRAO is direct external pressure on the eye. In these instances, the intraocular pressure exceeds systemic blood pressure, thereby decreasing blood flow through the central retinal artery with resultant retinal ischemia and vision loss.…”

mentioning

confidence: 99%

The Incidence of Vision Loss due to Perioperative Ischemic Optic Neuropathy Associated With Spine Surgery

Chang

Miller

2005

Spine

146

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POION is a rare but potentially devastating and untreatable complication of spine surgery, particularly that performed with the patient in the prone position. Anemia, hypotension, long duration of surgery, and significant intraoperative hydration may all be risk factors for this condition. All patients undergoing spine surgery should be informed about the low but definite risk of this condition, and every attempt should be made during surgery to maintain stable hemoglobin and mean arterial pressure and to avoid overhydration.

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confidence: 99%

The Incidence of Vision Loss due to Perioperative Ischemic Optic Neuropathy Associated With Spine Surgery

Chang

Miller

2005

Spine

146

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“…The study by Chang and Miller postulated that anemia, hypotension, long surgical duration, and significant intraoperative hydration were all risk factors for vision loss. 8 On multivariate analysis, another study found pediatric and elderly patients (>84 years) were at higher risk for vision loss; additionally, non-ION and non-CRAO visual loss risk factors included peripheral vascular disease (PVD), hypertension, and blood transfusion, whereas ION-related vision loss risk factors included hypotension, PVD, and anemia. 11 …”

Section: Discussionmentioning

confidence: 99%

“…Manfredini reported a case of prolonged compression of the eyeball during surgical fixation of a C5-C6 subluxation that resulted in blindness. 8 Abraham et al reported a case of unilateral vision loss presumed to be ION after fixation of an atlanto-axial dislocation in the prone position; they hypothesized that the patient’s vision loss could have been due to a combination of factors including malpositioned horseshoe head rest and surgery in the prone position. 7 Bekar also reported a case of CRAO as a result of cervical spine surgery in the prone position using a horseshoe head holder; they believed that prolonged ocular pressure caused the arterial occlusion.…”

Section: Discussionmentioning

confidence: 99%

Perioperative Vision Loss in Cervical Spinal Surgery

Gabel

Lam

Oskouian

et al. 2017

Global Spine Journal

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Study Design:Retrospective multicenter case series.Objective:To assess the rate of perioperative vision loss following cervical spinal surgery.Methods:Medical records for 17 625 patients from 21 high-volume surgical centers from the AOSpine North America Clinical Research Network who received cervical spine surgery (levels from C2 to C7) between January 1, 2005, and December 31, 2011, inclusive, were reviewed to identify occurrences of vision loss following surgery.Results:Of the 17 625 patients in the registry, there were 13 946 patients assessed for the complication of blindness. There were 9591 cases that involved only anterior surgical approaches; the remaining 4355 cases were posterior and/or circumferential fusions. There were no cases of blindness or vision loss in the postoperative period reported during the sampling period.Conclusions:Perioperative vision loss following cervical spinal surgery is exceedingly rare.

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“…We are aware of 933 documented cases of postoperative CRAO (Table 2), with the overwhelming majority seen following spinal surgery. 8,10,40,48,95,[97][98][99][100][101][102][103][104] Cases were also documented after hip/femur treatment, 33 knee replacement, 3 cholecystectomy, 3 appendectomy, 3 colorectal resection, 3 and cardiac surgery. 3 There was also one case following hip replacement in the lateral decubitus position without direct pressure on the orbit.…”

Section: Crao Literature Reviewmentioning

confidence: 99%

Perioperative visual loss in ocular and nonocular surgery

Berg

Harrison

Lee

2010

OPTH

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Incidence estimates for perioperative vision loss (POVL) after nonocular surgery range from 0.013% for all surgeries up to 0.2% following spine surgery. The most common neuro-ophthalmologic causes of POVL are the ischemic optic neuropathies (ION), either anterior (AION) or posterior (PION). We identified 111 case reports of AION following nonocular surgery in the literature, with most occurring after cardiac surgery, and 165 case reports of PION following nonocular surgery, with most occurring after spine surgery or radical neck dissection. There were an additional 526 cases of ION that did not specify if the diagnosis was AION or PION. We also identified 933 case reports of central retinal artery occlusion (CRAO), 33 cases of pituitary apoplexy, and 245 cases of cortical blindness following nonocular surgery. The incidence of POVL following ocular surgery appears to be much lower than that seen following nonocular surgery. We identified five cases in the literature of direct optic nerve trauma, 47 cases of AION, and five cases of PION following ocular surgery. The specific pathogenesis and risk factors underlying these neuro-ophthalmic complications remain unknown, and physicians should be alert to the potential for loss of vision in the postoperative period. Method of literature reviewWe searched the National Library of Medicine's PubMed database with a subsequent review of the accompanying references (last accessed February 8, 2010). The major search words and word combinations included: posterior ischemic optic neuropathy; anterior ischemic optic neuropathy; central retinal artery occlusion; pituitary apoplexy; cortical blindness; optic nerve trauma; postoperative vision loss; postoperative blindness; perioperative vision loss; perioperative blindness; and ocular surgery. In addition, the citations from the above searches were also included. Cases from the non-English literature and cases prior to 1970 were not included. Cases with documented direct surgical trauma to orbital structures other than the optic nerve were not included.

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Unilateral Blindness as a Complication of Intraoperative Positioning for Cervical Spinal Surgery

Cited by 24 publications

References 6 publications

The Incidence of Vision Loss due to Perioperative Ischemic Optic Neuropathy Associated With Spine Surgery

The Incidence of Vision Loss due to Perioperative Ischemic Optic Neuropathy Associated With Spine Surgery

Perioperative Vision Loss in Cervical Spinal Surgery

Perioperative visual loss in ocular and nonocular surgery

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