Transient visual acuity loss after spine surgery in prone position: A case report and literature review

Abstract

KEYWORDS 2 postoperative visual loss, visual acuity, ischemic optic neuropathy, retinal artery occlusion, prone position, spine surgery Abstract Background: Visual loss after spine surgery in prone position is disastrous postoperative complication because it is almost irreversible. Meamwhile, there is no optimal treatments and recommended peofessional guidelines. Case presentation: A 43 years old male patient complained visual loss after spine surgery in prone position. Immediate ophthalmic consultation undoubtedly considered central retinal artery occlusion, therefore combined therapies were administered including neurotrophy, anticoagulation, vasodilation and adequate fluid infusion, followed by hyperbaric oxygen treatment. After active treatment, his visual acuity recovered from postoperative 5 hours gradually. Conclusion: Because there is shortage of efficacious treatment against visual loss after spine surgery in prone position, the best method avoiding this complication is to pay great attention and prevent it. Background Visual loss after spine surgery in prone position is a rare complication, this incidence is about 0.017 to 1% [1, 2]. Although rare, it is potentially disastrous postoperative complication, even irreversible. Visual loss after spine surgery is attributable to various risk factors, including excessive blood loss, long prone spine surgery, hypoxia, use of vasoconstrictors, hypotension, high venous pressure, high volume fluid replacement, and poor head positioning [3]. These risks might lead to ischemic optic neuropathy (ION), central retinal artery occlusion (CRAO) and retinal vein occlusion. It has been reported patients with carotid stenosis or occlusion is also more vulnerable to this complication than those without stenosis [4]. Although CRAO and ION might be the ordinal mechanisms of postoperative visual loss (POVL) [5], the exact pathophysiologic mechanism has not been revealed [6]. Now we presented a case suffering transient unilateral visual loss after spine surgery in prone position under general anesthesia (GA), although who was without these recognized perioperative risk factors. Because of timely diagnosis and therapy, his visual acuity (VA) mostly resolved soon. This was a lucky case because of very quick recovery, which different from the most reported cases. Meanwhile possible etiologies and effective treatments were analyzed for avoiding this complication in future. Case PresentationA 43-year-old man was admitted with complain of repeated numb and pain on left low limb and

Applied anatomy and surgical technique of the lateral single‐position L5–S1 fusion

“…This lateral single‐position surgery allows the anterior, lateral, and posterior thoracolumbar spine to be accessed simultaneously. Single position lateral surgery can reduce the risks associated with prone position surgery such as endotracheal tube dislodgment (DePasse et al, 2015), increased abdominal pressure with associated increased bleeding with or without compartment syndrome (Shih et al, 2011), postoperative visual loss (Lee et al, 2017; Xiong et al, 2020), and thromboembolic (Nicol et al, 2009) and cardiovascular (DePasse et al, 2015; Dharmavaram et al, 2006) complications. By avoiding patient repositioning, surgical efficiency can be improved (Drazin et al, 2015) while reducing operation time (mean 44 min for repositioning of the patient, after adjusting for other factors), which results in lower hospital costs while not compromising postoperative lordosis and perioperative outcomes (Ziino et al, 2018).…”