Departmentof Anesthesiology and Pain Medicine, University of Washington, Box 356540BB, 1469 Health Sciences Building, 1959 N.E. Pacific Street, Seattle, WA 98195-6540, USA.
Spine (Phila Pa 1976). 2010 Apr 20;35(9 Suppl):S105-16. doi: 10.1097/BRS.0b013e3181d8344d.
Systematic literature review.
To determine if there are predictors or preventative measures for postoperative ischemic optic neuropathy (ION) associated with spine surgery.
Postoperative ION is a devastating complication that is most common after cardiac and spinal fusion surgery. Identifying patient or perioperative predictors for postoperative ION could lead to therapeutic modifications designed to minimize its occurrence.
A systematic literature review was conducted in MEDLINE, EMBASE, and the Cochrane Collaboration Library for literature published in English from 1990 through 2008 reporting on ION following spine surgery. References from review articles of ION were used, but articles without original material were excluded. Data on study design, patient demographics, and perioperative characteristics were collected and analyzed. Two independent reviewers assessed the strength of literature using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) criteria assessing quality, quantity, and consistency of results. Disagreements were resolved by consensus.
Nineteen of 360 articles on postoperative ION after spine surgery met inclusion/exclusion criteria. The quality of evidence was very low as the majority of articles were case reports. The majority of ION patients were men between 30 and 69 years, undergoing spinal fusion surgery with an operative duration greater than 5 hours and an estimated blood loss greater than 1 L. Confounding factors and lack of a denominator from the case reports and case series precluded identification of risk factors with even a modest level of evidence.
Postoperative ION after spinal surgery is a rare event, which may be associated with prone position surgery of more than 5 hours surgical duration and blood loss of more than 1 L. Informing patients of this remote risk should be considered during preoperative counseling. The quality of evidence for preventative measures for postoperative ION after spinal fusion surgery is very low, but it has been proposed that efforts aimed at reducing the duration or severity of venous congestion in the head may be beneficial.
系统文献回顾。
确定与脊柱手术相关的术后缺血性视神经病变（ION）是否存在预测因素或预防措施。
术后 ION 是一种破坏性的并发症，最常见于心内直视手术和脊柱融合术后。确定术后 ION 的患者或围手术期预测因素可能会导致治疗方法的修改，旨在最大程度地减少其发生。
在 MEDLINE、EMBASE 和 Cochrane 合作图书馆中进行了系统文献回顾，检索了 1990 年至 2008 年期间以英文发表的关于脊柱手术后 ION 的文献。使用了ION 综述文章的参考文献，但排除了没有原始资料的文章。收集并分析了研究设计、患者人口统计学和围手术期特征的数据。两位独立的评审员使用 Grading of Recommendations Assessment, Development and Evaluation（GRADE）标准评估文献的强度，该标准评估了结果的质量、数量和一致性。意见分歧通过协商解决。
19 篇符合纳入/排除标准的 360 篇脊柱手术后术后 ION 相关文章。证据质量非常低，因为大多数文章都是病例报告。大多数 ION 患者为 30 至 69 岁的男性，接受脊柱融合手术，手术时间超过 5 小时，估计失血量超过 1 升。病例报告和病例系列中的混杂因素和缺乏分母使得即使是中等水平的证据也无法确定危险因素。
脊柱手术后的 ION 是一种罕见的事件，可能与超过 5 小时的手术时间和超过 1 升的失血量的俯卧位手术有关。在术前咨询时应告知患者这种潜在的风险。脊柱融合术后预防术后 ION 的预防措施的证据质量非常低，但有人提出，旨在减少头部静脉充血的持续时间或严重程度的措施可能是有益的。
