Visual Field Defect After Posterior Spine Fusion

Katz, Danielle A.; Karlin, Lawrence I.

doi:10.1097/01.brs.0000152169.48117.c7

Cited by 27 publications

(11 citation statements)

References 30 publications

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“…This information might be useful for spine surgeons and anesthesiologists. Although post-operative stroke rarely happens in lumbar spinal surgery, it is repeatedly reported with various kinds of manifestations including blindness, weakness, impaired cognitive function, or even death [6][7][8][21][22][23][24][25][26]. Patients with spinal diseases usually need to pass a series of cardiac and pulmonary evaluations before being considered as candidates for spinal surgery, especially if they are old or have risk factors for cerebrovascular or heart diseases.…”

Section: Discussionmentioning

confidence: 99%

Lumbar spine fusion surgery and stroke: a national cohort study

Chen

Huang

et al. 2012

Eur Spine J

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Purpose To investigate the incidence and risk of stroke after lumbar spinal fusion surgery. Method Study subjects were identified from a nationwide cohort of 1 million people from 2000 to 2005 and were divided into the lumbar spinal fusion group (n = 2,015), who received posterior lumbar spinal fusion surgery, and the comparison group (n = 16,120) composed of age-, sex-, and propensity score-matched control subjects. The matching process was intended to adjust for demographics, comorbidities, and other immeasurable covariates to minimize selection bias. All subjects were followed up for 3 years for stroke, including hemorrhagic and ischemic strokes. Kaplan-Meier and Cox regression analyses were performed. ResultsThe overall incidence rate of stroke in the cohort was 9.99 per 1,000 person-year. The lumbar spinal fusion group was less likely to have any stroke (adjusted hazard ratio (HR) = 0.83, p = 0.293), hemorrhagic stroke (adjusted HR = 0.74, p = 0.739) and ischemic stroke (adjusted HR = 0.81, p = 0.250) than the comparison group, but without significance. Conclusions Three years post-operatively, patients who received lumbar spinal fusion had stroke incidence rates similar to those without surgery. Posterior lumbar spinal fusion surgery is not associated with increased risks for any kind of stroke.

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Section: Discussionmentioning

confidence: 99%

Lumbar spine fusion surgery and stroke: a national cohort study

Chen

Huang

et al. 2012

Eur Spine J

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“…Retinal ischemia has been documented in both adults and children following ocular trauma [32] , and also embolic [33] and vasospastic episodes [34] . With respect to spine surgery, these conditions are mostly commonly seen during the perioperative period from improper patient positioning and external compression on the eye [35] . Of the 93 cases submitted to the ASA Visual Loss Registry, there were 10 cases of CRAO [9] , representing a much smaller percentage than ION.…”

Section: Retinal Ischemia: Branch and Central Retinal Artery Occlusionmentioning

confidence: 99%

Perioperative visual loss after spine surgery

Nickels¹,

Manlapaz²,

Farag³

2014

WJO

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Perioperative visual loss (POVL) is an uncommon, but devastating complication that remains primarily associated with spine and cardiac surgery. The incidence and mechanisms of visual loss after surgery remain difficult to determine. According to the American Society of Anesthesiologists Postoperative Visual Loss Registry, the most common causes of POVL in spine procedures are the two different forms of ischemic optic neuropathy: anterior ischemic optic neuropathy and posterior ischemic optic neuropathy, accounting for 89% of the cases. Retinal ischemia, cortical blindness, and posterior reversible encephalopathy are also observed, but in a small minority of cases. A recent multicenter case control study has identified risk factors associated with ischemic optic neuropathy for patients undergoing prone spinal fusion surgery. These include obesity, male sex, Wilson frame use, longer anesthetic duration, greater estimated blood loss, and decreased percent colloid administration. These risk factors are thought to contribute to the elevation of venous pressure and interstitial edema, resulting in damage to the optic nerve by compression of the vessels that feed the optic nerve, venous infarction or direct mechanical compression. This review will expand on these findings as well as the recently updated American Society of Anesthesiologists practice advisory on POVL. There are no effective treatment options for POVL and the diagnosis is often irreversible, so efforts must focus on prevention and risk factor modification. The role of crystalloids versus colloids and the use of α-2 agonists to decrease intraocular pressure during prone spine surgery will also be discussed as a potential preventative strategy. Core tip: Perioperative visual loss (POVL) is an uncommon, but devastating complication that remains primarily associated with spine and cardiac surgery. The incidence and mechanisms of visual loss after surgery remain difficult to determine. Ischemic optic neuropathy accounts for the vast majority of these cases, with retinal ischemia, cortical blindness, and posterior reversible encephalopathy observed with low incidence. Recently identified risk factors include obesity, male sex, Wilson frame use, longer anesthetic duration, greater estimated blood loss, and decreased percent colloid administration. POVL is often permanent and untreatable, so prevention is key to limiting its impact. Nickels TJ, Manlapaz MR, Farag E. Perioperative visual loss after spine surgery. World J Orthop 2014; 5(2): 100-106 Available from:

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“…Of the 21 single case studies reviewed, the etiology of the POVL included: AACG (three patients), ION (three patients) CB (three patients), CRAO (four patients), ischemic orbital compartment syndrome/compression (one patients), CRA branch occlusion (one patient), or general POVL/unspecified etiology (six patients) [Tables 1 and 4 ]. [ 1 4 9 10 12 14 15 16 18 21 23 26 29 30 31 34 36 37 39 40 ] They variously cited a 0.28–0.2% versus 0.01–1% frequency of POVL following prone surgery, most commonly noting that hypotension was the major contributor. [ 14 40 ] However, other risk factors for POVL included; prolonged spine surgery, extensive instrumentation, increased intraoperative blood loss, anemia, cancer, use of catecholamines or nefopam, patent foramen ovale (right to left shunt), use of a prone view pillow, and application of Dupaco Opti-Gard eye goggles.…”

Section: Summary Of Case Studies Of Postoperative Visual Lossmentioning

confidence: 99%

Perioperative visual loss following prone spinal surgery: A review

Epstein

2016

Surg Neurol Int

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Background:Postoperative visual loss (POVL) following prone spine surgery occurs in from 0.013% to 1% of cases and is variously attributed to ischemic optic neuropathy (ION: anterior ION or posterior ION [reported in 1.9/10,000 cases: constitutes 89% of all POVL cases], central retinal artery occlusion [CRAO], central retinal vein occlusion [CRVO], cortical blindness [CB], direct compression [horseshoe, prone pillows, and eye protectors Dupaco Opti-Gard]), and acute angle closure glaucoma (AACG).Methods:Risk factors for ION include prolonged operative times, long-segment spinal instrumentation, anemia, intraoperative hypotension, diabetes, obesity, male sex, using the Wilson frame, microvascular pathology, decreased the percent of colloid administration, and extensive intraoperative blood loss. Risk factors for CRAO more typically include improper positioning during the surgery (e.g., cervical rotation), while those for CB included prone positioning and obesity.Results:POVL may be avoided by greater utilization of crystalloids versus colloids, administration of α-2 agonists (e.g., decreases intraocular pressure), avoidance of catecholamines (e.g., avoid vasoconstrictors), avoiding intraoperative hypotension, and averting anemia. Patients with glaucoma or glaucoma suspects may undergo preoperative evaluation by ophthalmologists to determine whether they require prophylactic treatment prior to prone spinal surgery and whether and if prophylactic treatment is warranted.Conclusions:The best way to avoid POVL is to recognize its multiple etiologies and limit the various risk factors that contribute to this devastating complication of prone spinal surgery. Furthermore, routinely utilizing a 3-pin head holder will completely avoid ophthalmic compression, while maintaining the neck in a neutral posture, largely avoiding the risk of jugular vein and/or carotid artery compromise and thus avoiding increasing IOP.

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Visual Field Defect After Posterior Spine Fusion

Abstract: Right-to-left atrial shunts may predispose to cerebral emboli during scoliosis surgery. These emboli may be a cause of postoperative visual field defects.

Cited by 27 publications

References 30 publications

Lumbar spine fusion surgery and stroke: a national cohort study

Lumbar spine fusion surgery and stroke: a national cohort study

Perioperative visual loss after spine surgery

Perioperative visual loss following prone spinal surgery: A review

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