VISUAL-LOSS AS A COMPLICATION OF SPINE SURGERY - A REVIEW OF 37 CASES

Study Design. Thirty-seven patients who experienced visual loss after spine surgery were identified through a survey of the members of the S coliosis Research Society and a review of the recent literature. Objec tives, Records were reviewed in an attempt to identify preoperative an d intraoperative risk factors and to assess the likelihood of recovery . Summary of Background Data, Postoperative blindness after spine surg ery has been documented in case reports or small series. The authors r eport the largest group of such cases to date and the first to allow c onclusions regarding risk and prognosis. Methods. Letters were sent to members of the Scoliosis Research Society requesting copies of medica l records concerning patients who experienced postoperative visual def icits after spine surgery. An additional 10 well-documented recent cas es were identified from published reports. Results. Patients with visu al loss had a mean age of 46.5 years. Surgery included instrumented po sterior fusion in 92% of the cases, with an average operative time of 410 minutes and blood loss of 3500 mL. Most cases had significant intr aoperative hypotension, with a mean drop in systolic blood pressure fr om 130 to 77 mm Hg. However, comparison with a matched group of patien ts with no Visual symptoms showed no differences in the hematocrit or blood pressure values. Visual loss occurred because of ischemic optic neuropathy, retinal artery occlusion, or cerebral ischemia. Eleven cas es were bilateral, and 15 patients had complete blindness in at least one eye. Most deficits were permanent. Conclusions. The authors conclu de that blindness after spine surgery is more common than has been rec ognized previously. Most cases are associated with complex instrumente d fusions.