LumbarIschemic Optic NeuropathyComplicating Spine Surgery-A Case Report
Dhurvas Ramlal Ramprasath1, Vasudevan Thirunarayanan2, Arjun Rajan3
1Department of Orthopaedics, Institute of Orthopaedics and Traumatology, Coimbatore Medical College Hospital, Coimbatore, Tamil Nadu, India.
Introduction:
Post-operative vision loss (POVL),i.e., blindness is an uncommon complication of any major surgery. In orthopedics, it is encountered mostly in spine surgery. POVL may be due to various pathologies such asischemic optic neuropathy (ION) and central retinal artery occlusion. A rise in intraocular pressure is one of the contributing factors. ION associated with lumbar spine surgery has been designated as lumbar ION. Even though its incidence is as low as 0.02%, once occurs, the consequence is disastrous. Our case of POVL due to posterior ION has certain distinct features which differentiate it from the routine cases reported in literature.
Case Report:
Our case is a 33-year-old gentleman who underwent revision lumbar spine surgery, for L3-L4 disc protrusion (recurrence) and L4-L5 disc protrusion with bilateral foot drop, in the form of posterior decompression, pedicle screw fixation from L3 to L5, and two-level transforaminal lumbar interbody fusion using cages. The patient developed POVL involving one eye which was diagnosed on operating table itself (immediately after extubation). Immediate appropriate treatment was initiated with the cooperation of ophthalmologist. The patient subsequently recovered, from no perception of light, to a visual acuity of 6/24, and is doing well regarding vision as well as neurology.
Conclusion:
Since POVL is an avoidable complication, knowledge regarding POVL and its contributing factors can lead to the prevention of the development of this complication. Moreover, since POVL has poor prognosis for recovery, prevention is the key. Since POVL can occur after any major surgery (apart from orthopedics), its knowledge can help surgeons in other specialties also.
