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Ischemic optic neuropathy following spine surgery.

Vivien T-G Ho1, Nancy J Newman, Suzan Song

  • 1Pritzker School of Medicine, University of Chicago, Chicago, Illinois 60637, USA.

Journal of Neurosurgical Anesthesiology
|January 6, 2005
PubMed
Summary

Perioperative visual loss (POVL) after spine surgery, often ischemic optic neuropathy (ION), is poorly understood. Prolonged prone positioning, low blood pressure, and significant blood loss may contribute to this devastating complication.

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Area of Science:

  • Ophthalmology
  • Neurosurgery
  • Anesthesiology

Background:

  • Perioperative visual loss (POVL) is a rare but severe complication following nonocular surgery.
  • Ischemic optic neuropathy (ION) is the most frequent cause of POVL.
  • Increasing reports of ION after spine surgery highlight a need to understand its etiology.

Purpose of the Study:

  • To review and analyze published case reports of ION following spine surgery performed in the prone position.
  • To identify potential risk factors and contributing elements to postoperative ION.

Main Methods:

  • MEDLINE literature search for case reports of ION after prone spine surgery.
  • Analysis of patient demographics, surgical characteristics, and clinical outcomes.
  • Categorization of ION into posterior (PION) and anterior (AION) types.

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Main Results:

  • Most cases involved PION (n=17) versus AION (n=5).
  • Onset within 24 hours was common; bilateral loss occurred in 40-47% of cases.
  • Significant factors included prolonged operative time (>450 min), low mean arterial pressure (64 mmHg), low hematocrit (27%), substantial blood loss (1.7-5 L), and large fluid volumes (8 L crystalloid, 2.2 L colloid).

Conclusions:

  • Prolonged prone spine surgery, reduced ocular perfusion, anemia, and excessive fluid administration are potential contributors to ION.
  • Intraoperative blood pressure and hematocrit levels were often within acceptable anesthetic ranges.
  • The precise etiology of postoperative ION remains incompletely understood, necessitating further investigation and preventative strategies.