Introduction: Ischemic optic neuropathy (ION) is the most common pathological diagnosis underlying postoperative vision loss. Spine surgery remains the largest source of perioperative ION amongst all surgical specialties. Most literature on ION following spine surgery has been in the form of case reports and small case series. Herein, we present an updated systematic review of the literature supplemented with the largest institutional case series reported so far to comprehensively explore clinical presentation, prognosis and perioperative risk factors.
Methods: We retrospectively retrieved all cases of ION diagnosed in the setting of spine surgery at our institution. We also conducted a systematic search of “Medline”, “Embase”, “Scopus” and identified all cases of perioperative ION following spine surgery reported in the literature. Following this, we pooled our results to descriptively analyze demographic, perioperative and follow up data and attempt to identify risk factors for prognosis.
Results: In addition to 12 patients from our institution diagnosed between 2004 and 2017, 182 patients were identified from the literature from 42 studies. Mean age of the cohort was 49+/-14 years with 60% males. Posterior ischemic optic neuropathy (PION) remained the most common diagnosis (58.7%). Fusions were the most common surgical intervention (86.5%) with the majority of cases arising in the setting of prone lumbar or thoracolumbar spine surgery (78.5%). Mean operative time was 561+/-219 minutes. At immediate postoperative presentation, PION was more likely to be associated blindness as compared to AION. Overall vision outcome remained poor with only 37.8% patients having improved on follow up.
Conclusions: PION is the most common cause of vision loss following spine surgery. Prone spine surgery especially multiple level instrumented fusions characterized by longer operative times and higher blood loss appear to be most associated with the development of this rare but devastating complication.
Patient Care: This study informs spine surgeons about the occurrence of perioperative ischemic optic neuropathy which constitutes the most common cause of vision loss following spine surgery. Factors influencing development of this rare but devastating complication are also discussed. This will lead to better and more informed preoperative counselling and risk stratification of patients.
Learning Objectives: -Importance of preoperative counseling about perioperative vision loss following spine surgery
-Factors influencing development of ischemic optic neuropathy following spine surgery.