Posterior Ischemic Optic Neuropathy after Cervical Spine Surgery

Purpose: To describe a patient with posterior ischemic optic neuropathy (PION) after cervical spine surgery who recovered after treatment.Case summary: A 51-year-old woman presented with eye pain and decreased visual acuity in the left eye, which had begun 8 hours after cervical spine surgery in the prone position. Her best-corrected visual acuity (BCVA) was 20/20 in the right eye and hand motion in the left eye; a relative afferent pupillary defect was present in the left eye. Ductions and versions were normal with pain in the left eye. The results of slit lamp examination, fundoscopic examination, fluorescein angiography, and optical coherence tomography were unremarkable in both eyes. Brain and orbital magnetic resonance imaging showed no abnormal findings in the visual pathway, such as brain infarction or intracranial artery stenosis. The patient was diagnosed with PION in the left eye. Because postoperative anemia had developed with a rapid decrease in hemoglobin from 14.7 g/dL to 9.9 g/dL, red blood cell (RBC) transfusion was performed together with intravenous high-dose steroid therapy and subcutaneous epoetin alfa injection. After 3 weeks, the patient’s BCVA improved to 20/22 in the left eye.Conclusions: Unilateral PION developed after cervical spine surgery in the prone position. Visual improvement was observed after RBC transfusion, intravenous high-steroid therapy, and subcutaneous epoetin alfa injection.

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Central Retinal Artery Occlusion after Cervical Spine Surgery in Prone Position: A Case Report

The Journal of the Korean Orthopaedic Association ◽

10.4055/jkoa.1996.31.4.928 ◽

1996 ◽

Vol 31 (4) ◽

pp. 928

Author(s):

Hak-Jin Min ◽

Keun-Woo Kim ◽

Yong-Hoon Kim ◽

Ui-Seoung Yoon ◽

Jin-Sup Yoem ◽

...

Keyword(s):

Case Report ◽

Cervical Spine ◽

Prone Position ◽

Spine Surgery ◽

Central Retinal Artery Occlusion ◽

Retinal Artery Occlusion ◽

Artery Occlusion ◽

Central Retinal Artery ◽

Cervical Spine Surgery ◽

Retinal Artery

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Perioperative cardiopulmonary complications after cervical spine surgery in the prone position: the relationship between age and preoperative testing

Archives of Orthopaedic and Trauma Surgery ◽

10.1007/s00402-010-1234-9 ◽

2010 ◽

Vol 131 (7) ◽

pp. 911-916 ◽

Cited By ~ 6

Author(s):

Gentaro Kumagai ◽

Kazunari Takeuchi ◽

Shuichi Aburakawa ◽

Toru Yokoyama ◽

Atsushi Ono ◽

...

Keyword(s):

Cervical Spine ◽

Prone Position ◽

Spine Surgery ◽

Preoperative Testing ◽

Cervical Spine Surgery ◽

Cardiopulmonary Complications ◽

The Relationship

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Prone Positioning of Patients with Cervical Spine Pathology

Journal of Neuroanaesthesiology and Critical Care ◽

10.1055/s-0039-1687918 ◽

2019 ◽

Vol 07 (02) ◽

pp. 070-076

Author(s):

Sarah L. Boyle ◽

Zoe Unger ◽

Vinay Kulkarni ◽

Eric M. Massicotte ◽

Lashmi Venkatraghavan

Keyword(s):

Cervical Spine ◽

Prone Position ◽

Spine Surgery ◽

Good Alternative ◽

Neurological Injury ◽

Prone Positioning ◽

Cervical Spine Surgery ◽

Advantages And Disadvantages ◽

Flexion Extension ◽

Spine Pathology

AbstractPatients with cervical trauma or degenerative disease often require surgical decompression and stabilization in the prone position and are at the risk of secondary neurological injury during this transfer. This review aims to explore the current literature on different methods of positioning patients prone and to identify the safest technique to achieve prone positioning in patients with an unstable cervical spine undergoing posterior cervical spine surgery. We searched the Embase, Medline, and Medline-in Process databases for literature in English related to prone positioning patients with cervical spine pathology undergoing spine surgery. Seventy-three citations were identified as relevant and reviewed in detail with 20 articles being identified as answering the clinical questions posed. Our literature review identified three methods of prone positioning patients with cervical pathology: logroll with manual in-line stabilization (MILS), rotating the patient on a specialized spinal table using a “sandwich and flip” technique, and awake prone positioning. Each of these methods has its own advantages and disadvantages. When comparing the degree of neck movement between positioning techniques, “sandwich and flip” rotation was associated with over 50% reduction in both flexion–extension and axial–lateral rotation as compared to logroll with MILS. Awake self-positioning of a patient is another alternative that allows for rapid neurological assessment after repositioning. A “sandwich and flip” is the safest way to turn a patient with cervical pathology into a prone position for surgery. For cooperative patients, who are physically capable, awake self-positioning is a good alternative.

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