Visual loss after spine surgery: a population-based study.
METHODS
Retrospective cohort study using National inpatient sample administrative data.


OBJECTIVE
To determine national estimates of visual impairment and ischemic optic neuropathy after spine surgery.


BACKGROUND
Loss of vision after spine surgery is rare but has devastating complications that has gained increasing recognition in the recent literature. National population-based studies of visual complications after spine surgery are lacking.


METHODS
All patients from 1993 to 2002 who underwent spine surgery (Clinical Classifications software procedure code: 3, 158) and who had ischemic optic neuropathy (ION) (ICD9-CM code 377.41), central retinal artery occlusion (CRAO) (ICD9-CM code 362.31) or non-ION, non-CRAO perioperative visual impairment (ICD9-CM codes: 369, 368.4, 368.8-9368.11-13) were included. Univariate and multivariate analysis were performed to identify potential risk factors.


RESULTS
The overall incidence of visual disturbance after spine surgery was 0.094%. Spine surgery for scoliosis correction and posterior lumbar fusion had the highest rates of postoperative visual loss of 0.28% and 0.14% respectively. Pediatric patients (<18 years) were 5.8 times and elderly patients (>84 years) were 3.2 times more likely than, patients 18 to 44 years of age to develop non-ION, non-CRAO visual loss after spine surgery. Patients with peripheral vascular disease (OR = 2.0), hypertension (OR = 1.3), and those who received blood transfusion (OR = 2.2) were more likely to develop non-ION, non-CRAO vision loss after spine surgery. Ischemic optic neuropathy was present in 0.006% of patients. Hypotension (OR = 10.1), peripheral vascular disease (OR = 6.3) and anemia (OR = 5.9) were the strongest risk factors identified for the development of ION.


CONCLUSIONS
We used multivariate analysis to identify significant risk factors for visual loss after spine surgery. National population-based estimate of visual impairment after spine surgery confirms that ophthalmic complications after spine surgery are rare. Since visual loss may be reversible in the early stages, awareness, evaluation and prompt management of this rare but potentially devastating complication is critical.
Department of Neurosurgery, Stanford University School of Medicine, Stanford, CA, USA.
Chirag G
CG
Patil
Eleonora M
EM
Lad
Shivanand P
SP
Lad
Chris
C
Ho
Maxwell
M
Boakye
D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000740:Anemia / Q000150:complications; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D006973:Hypertension / Q000150:complications; D007022:Hypotension / Q000150:complications; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D007297:Inpatients; D008159:Lumbar Vertebrae / Q000601:surgery; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D018917:Optic Neuropathy, Ischemic / Q000453:epidemiology / Q000209:etiology*; D019637:Orthopedic Procedures / Q000009:adverse effects* / Q000706:statistics & numerical data; D016491:Peripheral Vascular Diseases / Q000150:complications; D011159:Population Surveillance; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012600:Scoliosis / Q000150:complications / Q000601:surgery; D013123:Spinal Fusion / Q000009:adverse effects; D013131:Spine / Q000601:surgery*; D065227:Transfusion Reaction; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology; D014786:Vision Disorders / Q000453:epidemiology / Q000209:etiology*