Postoperative visual loss associated with spine surgery

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Abstract
Postoperative visual loss associated with spine surgery is a rare complication with no established definitive etiology. Multiple case reports have been published in the literature, and an overview of the case reports of the various visual disturbances following spine surgery is presented. Our objective was to review the current literature and determine if there were any risk factors that suggest what kind of patients have a higher likelihood of developing postoperative visual loss. Furthermore, analysis of factors common to the cases may offer a better understanding of possible etiologies leading to prevention strategies of postoperative visual loss. We used PubMed to perform a search of literature with spine surgery cases that are associated with visual disturbances. A total of 7 studies representing 102 cases were reviewed and evaluated in regard to age, sex, comorbidities, diagnosis, operative time, blood loss, systolic blood pressure, lowest hematocrit, and visual deficits and improvement. Ischemic optic neuropathy, especially posterior ischemic optic neuropathy, was the most common diagnosis found in the studies. The average age of the patients ranged from 46.5 years to 53.3 years with the majority having at least one comorbidity. Operative time ranged on average from 385 min to 410 min with a median in one case series of 480 min, average blood loss ranged from 3.5 l to 4.3 l and no visual improvement was seen in the majority of the cases. The etiology of postoperative visual loss is probably multifactorial, however, patients with a large amount of blood loss producing hypotension and anemia along with prolonged operative times may be causing a greater risk in developing visual disturbances. An acute anemic state may have an additive or synergistic effect with other factors (medical comorbidities) leading to visual disturbances. Although our study failed to provide definitive causative factors of postoperative visual loss, suggestions are made that warrant further studies.