Kern Singh (Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, USA) and others report in The Spine Journal that patients undergoing long-segment fusions for deformity should be counselled about the risks of perioperative visual loss because this complication occurs more frequently in these patients than patients undergoing other forms of spinal surgery.
Singh et al report that spinal surgery is a leading cause of the “rate but potentially catastrophic” complication of perioperative visual loss—particularly when patients are in the prone position (the prone position has itself been identified as a risk factor for the complication). However as perioperative visual loss is rare, data for the complication is limited. The authors write: “Much of the literature on visual loss associated with spinal surgery has consisted of individual case reports or small series of patients with optic neuropathies after various types of non-cardiac surgery.” They add that they reviewed data from the (USA) Nationwide Inpatient Survey to identify the risk factors for perioperative visual loss in patients undergoing spinal surgery.
Using data from the survey, Singh et al identified that 541, 485 spinal fusions were performed between 2002 and 2009 in the USA. Of these, there were 105 cases of perioperative visual loss (1.9 events per 10,000 cases). Nearly 60% (56.2%) of patients with visual loss had undergone surgery for spinal deformity correction even though, in the whole dataset, only 6% of patients underwent this type of surgery—the authors report: “Patients with a deformity diagnosis were at significantly increased risk for perioperative visual loss (p<0.0005).” Also, almost half (46.2%) of patients with perioperative visual loss underwent eight plus level fusions.
They note, “Within individual procedure groups, the incidence of perioperative visual loss was greatest after thoracic fusions affecting 53 of 26,863 (19.7 per 10,000) patients,” adding that within this subgroup of patients, 48.4% of procedures were performed for deformity and 35.8% were eight plus level fusions and 76.8% were three plus level fusions.
Concluding, the authors comment: “Despite being a rare complication following spinal surgery, perioperative visual loss is an adverse event that may not be entirely preventable. Patients undergoing long-segment fusions for deformity correction and those with certain risk factors [eg. diabetes with end-organ damage] should be counselled regarding the risks of perioperative visual loss.”
Singh told Spinal News International: “Patients should be aware of this small but present risk [of perioperative visual loss] when making surgical decisions and should definitely ask surgeons if they have risk factors that may increase this possibility. Surgeons should take this data and help to identify at risk patients, counsel them and discuss with the perioperative team.”