Perioperative visual loss after spine surgery

Nickels, Travis J; Manlapaz, Mariel; Farag, Ehab

doi:10.5312/wjo.v5.i2.100

Cited by 89 publications

(65 citation statements)

References 47 publications

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“…Subsequent reports established the causal relationship between increased intraocular pressure, decreased tissue perfusion, and perioperative visual loss (POVL). The rarity of this devastating complication has limited research [5] . The incidence of POVL after spine surgery ranges from 0.019% to 0.2%, with an increased risk during procedures involving prone positioning and in surgery for spinal deformity [6][7][8] .…”

Section: Opthamologic Complicationsmentioning

confidence: 99%

“…There is also an increased risk in patients with comorbidities such as diabetes mellitus with end organ damage, coagulopathy, neurologic disorders, and paralysis [6] . Despite the absence of large prospective studies, several etiologies of POVL have been described, including anterior and posterior ischemic optic neuropathy (AION and PION), central retinal artery occlusion (CRAO), and cortical blindness [5] (Table 1). Other rare etiologies have also been reported, including POVL associated with acute closedangle glaucoma and amaurosis [9,10] .…”

Section: Opthamologic Complicationsmentioning

confidence: 99%

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Complications associated with prone positioning in elective spinal surgery

DePasse

Palumbo

Haque

et al. 2015

WJO

202

117

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Complications associated with prone surgical positioning during elective spine surgery have the potential to cause serious patient morbidity. Although many of these complications remain uncommon, the range of possible morbidities is wide and includes multiple organ systems. Perioperative visual loss (POVL) is a well described, but uncommon complication that may occur due to ischemia to the optic nerve, retina, or cerebral cortex. Closed-angle glaucoma and amaurosis have been reported as additional etiologies for vision loss following spinal surgery. Peripheral nerve injuries, such as those caused by prolonged traction to the brachial plexus, are more commonly encountered postoperative events. Myocutaneous complications including pressure ulcers and compartment syndrome may also occur after prone positioning, albeit rarely. Other uncommon positioning complications such as tongue swelling resulting in airway compromise, femoral artery ischemia, and avascular necrosis of the femoral head have also been reported. Many of these are well-understood and largely avoidable through thoughtful attention to detail. Other complications, such as POVL, remain incompletely understood and thus more difficult to predict or prevent. Here, the current literature on the complications of prone positioning for spine surgery is reviewed to increase awareness of the spectrum of potential complications and to inform spine surgeons of strategies to minimize the risk of prone patient morbidity. Core tip: This review addresses the complications of prone positioning for spine surgery, which is an important and relatively underrepresented topic in the literature. Here, we address the wide range of complications by system, covering the most common complications, current understanding of pathophysiology, and strategies for prevention. Individual cases of very rare complications are also addressed. This article provides increased awareness and understanding of the risks of prone positioning, which is important for patient morbidity.

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Section: Opthamologic Complicationsmentioning

confidence: 99%

Section: Opthamologic Complicationsmentioning

confidence: 99%

Complications associated with prone positioning in elective spinal surgery

DePasse

Palumbo

Haque

et al. 2015

WJO

202

117

View full text Add to dashboard Cite

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“…surgery [7]. Nickels et al have published a detailed analysis of POVL and clearly identified the risk factors and diagnoses where ischemic optic neuropathy seemed to be an important cause for the loss of vision with Anterior ischemic optic neuropathy (AION) being the more common one [3]. Significant blood loss also has been postulated as one of the mechanisms of visual loss [6] [8].…”

Section: Case Reportmentioning

confidence: 99%

“…The presence of bilateral disc oedema post non ocular surgery is not a very common condition but has been documented. Ischemic optic neuropathy, central retinal artery occlusion (CRAO) and cortical blindness have been noted as the possible final diagnoses [3]. The various risk factors identified are pre-existing diabetes, anaemia, age over 50, small cup disc ratio, intraoperative hypotension and prolonged operative time in the prone position [6].…”

Section: Introduction and Literature Reviewmentioning

confidence: 99%

Transient Symptomatic Bilateral Optic Disc Oedema Following Lumbar Spinal Surgery— An Unusual Presentation

Jojo¹,

Jakhanwal²

2017

OJOph

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Background: Optic disc oedema has various underlying pathologies, however, unless visually disabling does not usually bring a patient to the physician. The more common symptoms of headache, nausea and vomiting lead to the incidental detection of bilateral disc oedema [1]. Optic disc oedema seen following spinal surgery is usually associated with visual acuity changes and often goes by the acronym POVL (Peri/ postoperative visual loss) wherein, as the name goes, visual acuity changes are profound Ophthalmic evaluation revealed normal visual acuity and pupils but marked disc edema right more significant than left. There was no colour vision deficit, neither any field changes. By a process of exclusion, it was likely the patient had developed bilateral disc oedema secondary to the spinal surgery. On follow-up 6 weeks and 3 months later, the oedema had completely settled and visual acuity remained at 6/6. Conclusion: Optic disc oedema can be unilateral or bilateral with some of the uncommon conditions mentioned secondary to spinal surgery, however, in those situations, visual loss has been severe and permanent. Our case is unusual in its combination of disc edema with normal acuity along with its transient nature and resolution and to our knowledge, has not been published before.

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“…1,3 According to the American Society of Anesthesiologists (ASA) Postoperative Visual Loss Registry, most common causes of POVL in spine procedures are anterior and posterior ischemic optic neuropathy, both of which together account for 89% of the cases. 4,5,6 Retinal ischemia, cortical blindness, and posterior reversible encephalopathy are also observed in a minority of cases.…”

Section: Introductionmentioning

confidence: 99%

Ophthalmological changes after posterior spine surgeries: A prospective study

2020

IJCA

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Introduction: Postoperative visual loss (POVL) after posterior approach to spine surgeries is a devastating complication necessitating a prospective study. The primary aim was to identify ophthalmological changes contributing to POVL (visual acuity, anterior segment, intraocular pressure (IOP), fundus, field of vision, external ocular examination). Secondary objectives was to evaluate the relationship between ophthalmological changes and various perioperative data including patient comorbidities, positioning and other intraoperative details. Materials and Methods: After getting necessary approvals and consent, thirty patients posted for the posterior spine surgeries were assessed preoperatively. Ophthalmological examination was conducted preoperatively, the day before surgery and postoperatively twice (first within an hour of completion of surgery and second at twenty four hours). Perioperatively, data including type of surgical frame, headrest used, duration of prone positioning, total blood loss, total intravenous fluids administered, lowest mean arterial pressure for more than ten minutes, blood transfusion details and use of hypotensive anaesthesia were noted. Data were analyzed using chi-square test, paired t test, and correlation coefficient. Results: There were no changes in visual acuity, anterior segment, fundus and field of vision postoperatively. But 12 patients had a rise in IOP and six developed lid edema and chemosis. There was a minimal increase in IOP at one hour post operatively (right eye-2.8 mm Hg (p=0.001, and left eye-3 mmHg(p<0.001). The analysis of perioperative data revealed no relationship with ophthalmological changes noted. Conclusion: There were no clinically significant ophthalmological changes contributing to POVL in spine surgeries in prone position. Observed ophthalmological changes did not have any correlation with patient comorbidities, positioning and other intraoperative details.

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Perioperative visual loss after spine surgery

Cited by 89 publications

References 47 publications

Complications associated with prone positioning in elective spinal surgery

Complications associated with prone positioning in elective spinal surgery

Transient Symptomatic Bilateral Optic Disc Oedema Following Lumbar Spinal Surgery— An Unusual Presentation

Ophthalmological changes after posterior spine surgeries: A prospective study

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