EDITORIAL
From the Department of Orthopaedic Surgery, Rush University Medical Center, in Chicago, Illinois.
Ocular Complications in Spine Surgery Visual perception is initiated as light reaches the cornea, a transparent structure continuous with the sclera. Incoming light is focused by the lens onto the retina, a neural tissue lined with photoreceptors that transduces visual stimuli into electrochemical signals. These signals then track posteriorly into the occipital lobe of the brain via the optic nerve to render visual perception. Although ocular complications are rare, they are increasingly being reported across several surgical fields, including orthopaedic, cardiothoracic, and general surgery.1–4 In 1948, Slocum et al documented the first spine surgery–linked case of blindness, which occurred as a result of incorrect intraoperative head positioning. 5 Over the past few decades, the complexity and number of spine surgeries has increased in the United States.6 According to a study from the Scoliosis Research Society, the frequency of eye complications is 1 per every 100 spinal procedures.7 Visual complications after spinal surgery can potentially bring about additional severe adverse postoperative outcomes for patients. Within spine surgery, perioperative vision loss (POVL) rates have been reported around 0.14% for lumbar fusion procedures and 0.28% for deformity correction cases. Individual patient characteristics such as preexisting health conditions, including hypertension, diabetes mellitus, and peripheral vascular disease or lifestyle
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Andrea M. Roca, MS
choices, such as smoking, may potentially increase the risk of experiencing POVL.7 Fatima N. Anwar, BA Complications POVL and central retinal artery occlusion (CRAO) are 2 of the most feared surgical complications by both patients and physicians because they often Alexandra C. Loya, BS culminate in visual field loss or irreversible blindness. However, corneal abrasion is the most commonly reported ocular complication.8,9 A corneal abrasion occurs when the epithelial layer Srinath S. Medakkar, BS of the cornea is separated from the underlying basement membrane. Corneal abrasions are generally classified by location, extent, and depth of the epitheRicha Singh, MD lial defect.9 Other less reported ocular complications include conjunctivitis, direct trauma, or chemical injury. Neurological origins for vision loss after surgery are also reportKern Singh, MD ed. Posterior reversible encephalopathy syndrome (PRES) is a neurological condition characterized by symptoms like seizures, vision disturbances, headaches, and a reduced level of alertness. While it is
Vertebral Columns
Fall 2023
