Ischemic optic neuropathy following lumbar spine surgery. Case report

Area of Science:

• Ophthalmology
• Neurosurgery
• Anesthesiology

Background:

• Spine surgery, particularly lumbar procedures, carries risks beyond the surgical site.
• Maintaining low intraoperative blood pressure to minimize bleeding can lead to significant blood loss.
• Anemia and hypotension are potential complications following major surgical interventions.

Observation:

• A patient experienced sudden visual loss in the right eye post-lumbar spine surgery.
• Significant intraoperative blood loss (1500 cc) and a drop in hemoglobin (4.2 g/dl) were noted.
• Ophthalmological examination revealed decreased visual acuity, color vision, and visual field, progressing to optic nerve atrophy.

Findings:

• The clinical presentation was consistent with ischemic optic neuropathy.
• This complication occurred despite an otherwise uncomplicated lumbar spine surgery.
• The patient's visual deficits were attributed to severe anemia and potentially hypotension during surgery.

Implications:

• Neurosurgeons must be vigilant for postoperative visual loss in patients undergoing lumbar spine surgery.
• Early ophthalmological consultation is essential for diagnosing and managing ischemic optic neuropathy.
• Prompt management including blood pressure and hematocrit correction may improve outcomes for patients with this condition.