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European Spine Journal

, Volume 20, Issue 2, pp 171–176 | Cite as

Amaurosis after spine surgery: survey of the literature and discussion of one case

  • Stephan ZimmererEmail author
  • Markus Koehler
  • Stephanie Turtschi
  • Anja Palmowski-Wolfe
  • Thierry Girard
Review Article

Abstract

Postoperative vision loss (POVL) associated with spine surgery is a well known, albeit very rare complication. POVL incidence after spinal surgery ranges from 0.028 to 0.2%; however, due to the increase in number and duration of annual complex spinal operations, the incidence may increase. Origin and pathogenesis of POVL remain frequently unknown. A 73-year-old patient presented with lumbar disc herniation with associated neurological deficits after conservative pre-treatment at a peripheral hospital. Known comorbidities included arterial hypertension, moderate arterial sclerosis, diabetes mellitus type 2, mildly elevated blood lipids and treated prostate gland cancer. During lumbar spine surgery in modified prone position the patient presented with an acute episode of severe hypotension, which required treatment with catecholamines and Trendelenburg positioning. Three hours postoperatively, a visual loss in the right eye occurred, resulting in a complete amaurosis. Antihypertensive medication, arteriosclerosis and intraoperative hypotension are possible causes for the POVL. Intraoperative administration of catecholamines and Trendelenburg positioning for treatment of systemic hypotension might further compromise ocular perfusion. In patients with comorbidities compromising arterial blood pressure, blood circulation and microcirculation, POVL must be considered as a severe postoperative complication. It is recommended to inform patients about such complications and obtain preoperative informed consent regarding POVL. Any recent modification of antihypertensive medication must be reported and analysed for potential intraoperative hemodynamic consequences, prior to spine surgery in prone position.

Keywords

Amaurosis Blood pressure Spinal surgery Prone position Postoperative vision loss (POVL) 

Notes

Acknowledgments

The authors would like to thank the staff of the Department of Ophthalmology as well as Petra Schwenzer and Virginia Dittrich for their support in editing. The manuscript submitted does not contain information about medical device(s)/drug(s). No funds were received in support of this work. No benefits in any form have been or will be received from a commercial party related directly or indirectly to the subject of this manuscript.

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Copyright information

© Springer-Verlag 2010

Authors and Affiliations

  • Stephan Zimmerer
    • 1
    Email author
  • Markus Koehler
    • 2
  • Stephanie Turtschi
    • 3
  • Anja Palmowski-Wolfe
    • 3
  • Thierry Girard
    • 4
  1. 1.Department of NeurosurgeryUniversity Hospital BaselBaselSwitzerland
  2. 2.Bethesda Spital BaselBaselSwitzerland
  3. 3.Department of OphthalmologyUniversity Hospital BaselBaselSwitzerland
  4. 4.Department of AnaesthesiaUniversity Hospital BaselBaselSwitzerland

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