How to avoid perioperative visual loss following prone spinal surgery

Area of Science:

• Neurosurgery
• Ophthalmology
• Anesthesiology

Background:

• Postoperative visual loss (POVL) affects 0.013%–0.2% of prone spine surgeries.
• POVL is primarily caused by ischemic optic neuropathy (ION), central retinal artery occlusion (CRAO), or cortical blindness (CB).
• Direct compression and glaucoma are less common causes of POVL.

Purpose of the Study:

• To review the causes of POVL in prone spine surgery.
• To identify risk factors associated with POVL.
• To outline preventive strategies to mitigate POVL risk.

Main Methods:

• Review of literature on POVL following prone spinal surgery.
• Identification of risk factors for ION, CRAO, and CB.
• Analysis of preventive measures and their efficacy.

Main Results:

• Risk factors for ION include prolonged surgery, anemia, hypotension, and diabetes.
• CRAO can result from improper head positioning causing venous or carotid compression.
• CB is often linked to direct compression and obesity.

Conclusions:

• Preventing POVL is paramount in prone spine surgery.
• Routine use of an arterial line and intraoperative monitoring aids in managing hypotension and anemia.
• A 3-pin head holder and 10° head elevation minimize direct eye compression and reduce intraocular pressure.