Department of Orthopaedic Surgery, Columbia University Medical Center, The Spine Hospital at New York Presbyterian, New York, NY.
NYU Orthopaedic Surgery Associates.
Spine (Phila Pa 1976). 2018 Sep 1;43(17):1201-1207. doi: 10.1097/BRS.0000000000002592.
A retrospective review of the Scoliosis Research Society (SRS) morbidity and mortality (M&M) database.
The aim of this study was to investigate visual related complications in spinal deformity patients undergoing spine surgery.
The SRS compiles surgeon-reported complications into an M&M database, tracking postoperative complications including visual loss, neurological deficits, infections, and death. Limited literature exists on postoperative visual complications, a rare but devastating complication following spine surgery.
We utilized the SRS M&M database to determine demographics, perioperative risk factors, and prognosis for visual related complications in spinal deformity patients undergoing corrective spine surgery from 2009 to 2012.
A total of 167,972 spinal deformity patients from 2009 to 2012 were identified with a visual acuity complication (VAC) rate of 0.01%, or 12.5 per 100,000 patients. VAC rates for patients with kyphosis were significantly higher than patients with scoliosis (0.049% vs. 0.010%, P = 0.002) and spondylolisthesis (0.049% vs. 0.005%, P = 0.001). Postoperative visual loss rates significantly decreased from 2010 to 2012 (0.022% vs. 0.004%, P = 0.029). Twenty-one patients identified with VACs had a mean age of 34.8 ± 24.3 years. Two (9.5%) patients had preoperative vision changes, two (9.5%) were diabetic, two (9.5%) had vascular disease, one (4.8%) had a history of thromboembolic disease, and five (23.8%) had hypertension. Extent of VAC was bilateral-partial in four (19.0%), bilateral-total in five (23.8%), unilateral-partial in eight (38.1%), and unilateral-total in three (14.3%) patients. Four (19.0%) patients developed anterior ischemic optic neuropathy, four (19.0%) had posterior ischemic optic neuropathy (PION), five (23.8%) had central retinal artery occlusion, and five (23.8%) developed cortical blindness (CB). Greater than 50% of the VACs occurred on, or before, the first postoperative day. Ten (47.6%) patients recovered complete vision and four (19.0%) improved. All patients with CB and 50% with posterior ischemic optic neuropathy experienced complete resolution.
VACs occur in approximately 12.5 per 100,000 deformity patients, with a rate five times higher in patients with kyphosis. More than 50% of these complications occur within 24 hours postoperatively. Nearly half of these complications resolve completely, and another 19% improve postoperatively.
回顾性分析脊柱侧凸研究学会（SRS）发病率和死亡率（M&M）数据库。
本研究旨在调查脊柱畸形患者脊柱手术后与视觉相关的并发症。
SRS 将外科医生报告的并发症汇编到 M&M 数据库中，跟踪术后并发症，包括视力丧失、神经功能缺损、感染和死亡。关于术后视觉并发症的文献有限，这是脊柱手术后一种罕见但具有破坏性的并发症。
我们利用 SRS M&M 数据库确定了 2009 年至 2012 年间接受脊柱矫正手术的脊柱畸形患者的人口统计学、围手术期危险因素和与视觉相关并发症的预后。
2009 年至 2012 年间，共确定了 167972 例脊柱畸形患者，视力障碍并发症（VAC）发生率为 0.01%，即每 100000 例患者中有 12.5 例。后凸畸形患者的 VAC 发生率明显高于侧凸和脊椎滑脱患者（0.049%比 0.010%，P=0.002 和 0.049%比 0.005%，P=0.001）。2010 年至 2012 年，术后视力丧失率显著下降（0.022%比 0.004%，P=0.029）。21 例 VAC 患者的平均年龄为 34.8±24.3 岁。两名（9.5%）患者术前有视力改变，两名（9.5%）为糖尿病患者，两名（9.5%）有血管疾病，一名（4.8%）有血栓栓塞病史，五名（23.8%）有高血压。VAC 的严重程度为：四名（19.0%）为双侧部分性，五名（23.8%）为双侧完全性，八名（38.1%）为单侧部分性，三名（14.3%）为单侧完全性。四名（19.0%）患者发生前部缺血性视神经病变，四名（19.0%）发生后部缺血性视神经病变（PION），五名（23.8%）发生视网膜中央动脉阻塞，五名（23.8%）发生皮质盲（CB）。超过 50%的 VAC 发生在术后第 1 天或之前。10 名（47.6%）患者视力完全恢复，4 名（19.0%）患者视力改善。所有 CB 和 50%的 PION 患者完全恢复。
VAC 约占畸形患者的 12.5/100000，后凸畸形患者的发生率高 5 倍。这些并发症中有超过 50%在术后 24 小时内发生。近一半的并发症完全缓解，另有 19%的并发症术后改善。
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