title: Amaurosis after spine surgery: survey of the literature and discussion of one case.
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.
authors.affiliation: Department of Neurosurgery, University Hospital Basel, Basel, Switzerland. zimmerers@uhbs.ch
authors.forename: Stephan
authors.initials: S
authors.lastname: Zimmerer
authors.forename: Markus
authors.initials: M
authors.lastname: Koehler
authors.forename: Stephanie
authors.initials: S
authors.lastname: Turtschi
authors.forename: Anja
authors.initials: A
authors.lastname: Palmowski-Wolfe
authors.forename: Thierry
authors.initials: T
authors.lastname: Girard
mesh_terms: D000368:Aged; D001766:Blindness / Q000209:etiology*; D006801:Humans; D007405:Intervertebral Disc Displacement / Q000601:surgery*; D008159:Lumbar Vertebrae / Q000601:surgery*; D019637:Orthopedic Procedures / Q000009:adverse effects*
references.citation: J Bone Joint Surg Am. 1993 Aug;75(8):1231-2
references.pmid: 8354684
references.citation: Can J Anaesth. 2004 Apr;51(4):388-92
references.pmid: 15064270
references.citation: Br J Anaesth. 2005 Aug;95(2):257-60
references.pmid: 15951324
references.citation: J Spinal Disord Tech. 2007 Jun;20(4):302-7
references.pmid: 17538355
references.citation: Klin Oczna. 2006;108(4-6):238-42
references.pmid: 17020004
references.citation: Neurosurg Focus. 2007;23(5):E15
references.pmid: 18004963
references.citation: AANA J. 2004 Aug;72(4):285-92
references.pmid: 15354918
references.citation: Anesthesiology. 2002 Jun;96(6):1531; author reply 1532
references.pmid: 12170078
references.citation: Am J Ophthalmol. 2004 Nov;138(5):889-91
references.pmid: 15531342
references.citation: Int Surg. 2004 Oct-Dec;89(4):209-11
references.pmid: 15730101
references.citation: Spine (Phila Pa 1976). 2005 Jun 1;30(11):1299-302
references.pmid: 15928556
references.citation: Anesteziol Reanimatol. 2008 Mar-Apr;(2):88-91
references.pmid: 18540473
references.citation: Masui. 2009 Aug;58(8):952-61
references.pmid: 19702207
references.citation: Spine (Phila Pa 1976). 1993 Jul;18(9):1226-8
references.pmid: 8362331
references.citation: Anesth Analg. 2001 Dec;93(6):1417-21, table of contents
references.pmid: 11726416
references.citation: Anesthesiology. 2001 Sep;95(3):575-7
references.pmid: 11575526
references.citation: Indian J Ophthalmol. 2007 Sep-Oct;55(5):401-2
references.pmid: 17699964
references.citation: Spine (Phila Pa 1976). 2005 Feb 1;30(3):E83-5
references.pmid: 15682002
references.citation: Anaesthesist. 2006 Apr;55(4):457-64
references.pmid: 16416143
references.citation: Rev Esp Anestesiol Reanim. 2007 Dec;54(10):621-5
references.pmid: 18200998
references.citation: J Spinal Disord. 2000 Jun;13(3):271-2
references.pmid: 10872768
references.citation: J Neurosurg Anesthesiol. 2004 Oct;16(4):322-3
references.pmid: 15557844
references.citation: Insight. 2005 Jan-Mar;30(1):10-7
references.pmid: 15945413
references.citation: J Am Acad Orthop Surg. 2007 Mar;15(3):156-65
references.pmid: 17341672
references.citation: Anesth Analg. 2007 May;104(5):1185-7, tables of contents
references.pmid: 17456671
references.citation: Br J Anaesth. 2009 Dec;103 Suppl 1:i31-40
references.pmid: 20007988
references.citation: Bull Soc Belge Ophtalmol. 2007;(305):27-30
references.pmid: 18018424
references.citation: Singapore Med J. 2008 Apr;49(4):e96-7
references.pmid: 18418515
references.citation: Korean J Ophthalmol. 2006 Jun;20(2):139-42
references.pmid: 16892653
references.citation: J Neurosurg Anesthesiol. 1996 Jul;8(3):227-9
references.pmid: 8803835
references.citation: Anesthesiol Clin North Am. 2002 Sep;20(3):605-622, viii
references.pmid: 12298309
references.citation: Paediatr Anaesth. 2007 Aug;17(8):805-8
references.pmid: 17596227
references.citation: Br J Anaesth. 2008 Sep;101(3):380-2
references.pmid: 18544522
references.citation: J Neurosurg Anesthesiol. 2005 Jan;17(1):38-44
references.pmid: 15632541
references.citation: Anesthesiol Clin North Am. 2002 Jun;20(2):405-15, vii
references.pmid: 12166002
references.citation: Anesthesiology. 2006 Oct;105(4):652-9; quiz 867-8
references.pmid: 17006060
references.citation: Singapore Med J. 2006 Jul;47(7):631-3
references.pmid: 16810440
references.citation: Anesthesiology. 2007 Jun;106(6):1249; author reply 1251-2
references.pmid: 17525613
references.citation: Neurosurgery. 2000 Mar;46(3):625-30; discussion 630-1
references.pmid: 10719859
references.citation: Anesthesiology. 2002 Apr;96(4):855-9
references.pmid: 11964592
references.citation: Anesthesiology. 2002 Jun;96(6):1531-2; author reply 1532-3
references.pmid: 12170079
references.citation: Eur Spine J. 2006 Apr;15(4):479-84
references.pmid: 15926057
references.citation: Anesthesiology. 2006 Jun;104(6):1319-28
references.pmid: 16732103
references.citation: Ann Fr Anesth Reanim. 2009 Feb;28(2):165-7
references.pmid: 19186025
references.citation: Anesth Analg. 2009 Nov;109(5):1534-45
references.pmid: 19713263
references.citation: Anesthesiology. 2001 Sep;95(3):793-5
references.pmid: 11575556
references.citation: Spine (Phila Pa 1976). 1994 Feb 15;19(4):468-9
references.pmid: 8178240
references.citation: Semin Neurol. 2007 Jul;27(3):199-210
references.pmid: 17577862
references.citation: J Am Coll Surg. 2002 Jun;194(6):705-10
references.pmid: 12081060
references.citation: Neurologist. 2008 Nov;14(6):341-54
references.pmid: 19008740
references.citation: Anesth Analg. 2005 Jan;100(1):192-195
references.pmid: 15616077
references.citation: Spine (Phila Pa 1976). 2008 Jun 1;33(13):1491-6
references.pmid: 18520945
references.citation: Eur J Ophthalmol. 2007 Sep-Oct;17(5):844-6
references.pmid: 17932866
references.citation: Am J Ophthalmol. 2008 Apr;145(4):604-610
references.pmid: 18358851
references.citation: Spine (Phila Pa 1976). 1997 Jun 15;22(12):1325-9
references.pmid: 9201835
references.citation: Spine (Phila Pa 1976). 1997 Jun 15;22(12):1319-24
references.pmid: 9201834
references.citation: Klin Monbl Augenheilkd. 2004 May;221(5):421-3
references.pmid: 15162297