Advertisement

Postoperative Visual Loss Following Spinal Surgery

  • Lorri A. Lee
Chapter

Abstract

Postoperative visual loss (POVL) is a devastating perioperative complication that has received increased attention from anesthesiologists, spine surgeons, and neuro-ophthalmologists over the last 20 years. The most common types of surgical procedures associated with POVL include prone spine surgery, cardiopulmonary bypass procedures, head and neck procedures, and major vascular procedures. The highest reported incidence of symptomatic visual loss is 4.5% in cardiac cases and 0.2% in spine surgery. Concerted efforts from multiple organizations and groups in anesthesiology, neuro-ophthalmology, and surgery have identified risk factors for ischemic optic neuropathy (ION) associated with prone spine surgery, and they developed advisories and recommendations for the prevention of this complication. Recent data from the Nationwide Inpatient Sample indicates that the incidence of ischemic optic neuropathy associated with spine surgery is now decreasing.

Keywords

Postoperative visual loss/perioperative visual loss Ischemic optic neuropathy Central retinal artery occlusion Practice advisory for perioperative visual loss associated with spine surgery American Society of Anesthesiologists Postoperative Visual Loss Registry Elevated venous pressure in the prone position Wilson spine frame Case-control study for ischemic optic neuropathy Risk factors for ischemic optic neuropathy associated with spine surgery Horseshoe headrest 

Suggested Reading

  1. American Society of Anesthesiologists Task Force on Perioperative Visual Loss. Practice advisory for perioperative visual loss associated with spine surgery: an updated report by the American Society of Anesthesiologists Task Force on Perioperative Visual Loss. Anesthesiology. 2012;116(2):274–85.CrossRefGoogle Scholar
  2. Holy SE, Tsai JH, McAllister RK, Smith KH. Perioperative ischemic optic neuropathy: a case control analysis of 126,666 surgical procedures at a single institution. Anesthesiology. 2009;110:246–53.PubMedGoogle Scholar
  3. Lee LA, Nathens AB, Sires BS, McMurray MK, Lam AM. Blindness in the ICU: possible role for vasopressors? Anesth Analg. 2005;100:192–5.CrossRefGoogle Scholar
  4. Lee LA, Roth S, Posner KL, Cheney FW, Caplan RA, Newman NJ, et al. The American Society of Anesthesiologists’ Postoperative Visual Loss Registry: analysis of 93 spine surgery cases with postoperative visual loss. Anesthesiology. 2006;105:652–9.CrossRefGoogle Scholar
  5. Lee LA, Deem S, Glenny R, Townsend I, Moulding J, An D, et al. The effects of anemia and hypotension on porcine optic nerve blood flow and oxygen delivery. Anesthesiology. 2008;108:864–72.CrossRefGoogle Scholar
  6. Myers MA, Hamilton SR, Bogosian AJ, Smith CH, Wagner TA. Visual loss as a complication of spine surgery: a review of 37 cases. Spine. 1997;22:1325–9.CrossRefGoogle Scholar
  7. Patil CJ, Lad EM, Lad SP, Ho C, Boakye M. Visual loss after spine surgery: a population based study. Spine. 2008;33:1491–6.CrossRefGoogle Scholar
  8. Postoperative Visual Loss Study Group. Risk factors associated with ischemic optic neuropathy after spinal fusion surgery. Anesthesiology. 2012;116(1):15–24.Google Scholar
  9. Roth S. In: Miller RD, editor. Postoperative blindness, anesthesia. 6th ed. New York: Elsevier/Churchill Livingstone; 2005. p. 2991–3020.Google Scholar
  10. Rubin DS, Parakati I, Lee LA, Moss HE, Joslin CE, Roth S. Perioperative visual loss in spine fusion surgery: ischemic optic neuropathy in the United States from 1998 to 2012 in the nationwide inpatient sample. Anesthesiology. 2016. [Epub ahead of print].Google Scholar
  11. Shen Y, Drum M, Roth S. The prevalence of perioperative visual loss in the United States: a 10-year study from 1996 to 2005 of spinal, orthopedic, cardiac, and general surgery. Anesth Analg. 2009;109:1534–45.CrossRefGoogle Scholar
  12. Practice Advisory for Perioperative Visual Loss Associated with Spine Surgery. An updated report by the American Society of Anesthesiologists task force on perioperative visual loss, the North American Neuro-Ophthalmology Society, and the society for Neuroscience in Anesthesiology and Critical Care. Anesthesiology. 2019;130(1):12–30.Google Scholar
  13. Rubin DS, Parakati I, Lee LA, Moss HE, Joslin CE, Roth S. Perioperative visual loss in spine fusion surgery: ischemic optic neuropathy in the United States from 1998 to 2012 in the Nationwide Inpatient Sample. Anesthesiology. 2016;125(3):457–64.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2020

Authors and Affiliations

  • Lorri A. Lee
    • 1
  1. 1.Department of AnesthesiologyKadlec Regional Medical CenterRichlandUSA

Personalised recommendations