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Related Experiment Video

Updated: Jul 25, 2026

Intraoperative Ultrasound in Spinal Surgery
05:53

Intraoperative Ultrasound in Spinal Surgery

Published on: August 17, 2022

Unilateral visual loss after cervical spine surgery.

Mary Abraham1, Navin Sakhuja, Sanjiv Sinha

  • 1Department of Anesthesiology, G B Pant Hospital, New Delhi, India. maryabraham@hotmail.com

Journal of Neurosurgical Anesthesiology
|September 26, 2003
PubMed
Summary

A young patient developed painless vision loss after spine surgery due to ischemic optic neuropathy (ION). This complication may arise from surgical positioning and headrest use, even without typical risk factors.

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Area of Science:

  • Ophthalmology
  • Neurosurgery
  • Anesthesiology

Background:

  • Atlanto-axial dislocation requires surgical correction, often in the prone position.
  • Spine surgery, particularly in the prone position, carries risks of postoperative complications.
  • Ischemic optic neuropathy (ION) is a potential, though uncommon, complication following spinal procedures.

Observation:

  • A patient undergoing uneventful atlanto-axial dislocation surgery in the prone position developed sudden, painless, unilateral vision loss.
  • Ophthalmologic examination suggested ischemic optic neuropathy (ION) as the probable diagnosis.
  • While visual acuity recovered within a month, visual field defects and color vision abnormalities persisted.

Findings:

  • The patient was young and healthy, with no reported intraoperative complications like anemia or hypotension.

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  • The surgery was uneventful, ruling out common risk factors for ION.
  • Potential contributing factors identified include malpositioning of a horseshoe headrest and the prone surgical position, which can increase intraocular pressure and decrease optic nerve perfusion pressure.

    • Implications:

    • This case highlights that ION can occur in healthy patients after spine surgery even without typical intraoperative risk factors.
    • The findings suggest that factors related to surgical positioning, such as headrest placement and prone posture, may play a significant role.
    • Understanding these unique risk factors is crucial for preventing vision loss complications in spine surgery.