Ischaemic optic neuropathy after spinal fusion

• DOI: 10.1007/bf03011996
• Publication Date: 2009-05-01T23:39:33Z
• Authors: John A. Dilger; John E. Tetzlaff; Gordon R. Bell; Gregory S. Kosmorsky; Ross C. Agnor; Jerome F. O’Hara
• Keywords: Adult; Male; Blood Loss, Surgical; Nitrous Oxide; Hemorrhage; Immobilization; 03 medical and health sciences; 0302 clinical medicine; Humans; Optic Neuropathy, Ischemic; Obesity; 2. Zero hunger; Lumbar Vertebrae; Isoflurane; Laminectomy; Optic Nerve; Magnetic Resonance Imaging; 3. Good health; Fentanyl; Diabetes Mellitus, Type 1; Neuromuscular Depolarizing Agents; Anesthetics, Inhalation; Anesthesia, Intravenous; Anesthetics, Intravenous

We report a case of ischaemic optic neuropathy which occurred after prolonged spine surgery in the prone position in an obese, diabetic patient.The patient was a 44-yr-old, 123 kg, 183 cm man for decompressive laminectomy and instrumented fusion of the lumbar spine. Anaesthesia was induced with thiopentone, fentanyl and succinylcholine and maintained with nitrous oxide, oxygen, isoflurane and a fentanyl infusion. He was positioned prone on the Relton-Hall frame and had an uneventful intraoperative course. Estimated blood loss was 3,000 ml. He was taken to the surgical intensive care unit (SICU) and the trachea was extubated 3.5 hr later. He had no pulmonary or haemodynamic problems and went to a regular nursing floor in the morning. He was discharged home on postoperative day #5. He telephoned his surgeon on postoperative day #7 to say that his vision had been blurry since surgery. His visual acuity was decreased, and on examination, he had a bilateral papillary defect, optic swelling and a splinter haemorrhage in the right eye. Magnetic resonance imaging (MRI) scan of the head and orbits detected no other abnormality. Based on this examination, he was felt to have bilateral ischaemic optic neuropathy and treated conservatively. By postoperative day #47, his visual acuity was greatly improved and near normal. Careful review of possible contributing factors suggests that the cause of the ischaemic optic neuropathy was venous engorgement.This patient developed ischaemic optic neuropathy from a prolonged interval in the prone position of the Relton-Hall frame, which may be related to venous engorgement.