Papaioannou Ioannis, Xristopoulos Konstantinos, Baikousis Andreas, Korovessis Panagiotis, Kokkinis Kyriakos
Department of Orthopedic, General Hospital of Patras Spine and Trauma Unit, Patras, Greece.
Department of Ophthalmology, General Hospital of Patras, Patras, Greece.
J Orthop Case Rep. 2019;9(4):92-95. doi: 10.13107/jocr.2019.v09.i04.1496.
Ocular complications after spine surgery in prone position are very rare and are described centrally in elective surgeries with long duration. The most well-known ocular complications are vision loss and acute angle-closure glaucoma. To the best of our knowledge, anisocoria after prone spinal surgery has never been reported previously in literature.
We present a very rare case of a transient harmless anisocoria in a 23-year-old otherwise healthy female patient, who underwent in the traditionally prone position lumbosacral spinal fractures stabilization and calcaneal fracture reduction and external fixation. We describe step by step the diagnosis algorithm and we discuss detaily the differential diagnosis of the unilaterally fixed and dilated pupil. Careful stepwise medical history and examination are mandatory to establish correct diagnosis and avoid unnecessary, expensive, and potentially hazardous or invasive diagnostic testing.
The wrong position during prone spine surgery can cause iris sphincter muscle tears and transient or permanent dilation of the affected pupil. Fixed dilated pupil is a permanent abnormality of the iris, causing irregular cosmetic appearance, especially in young females, and requires further conservative or surgical intervention. Positioning of the patient and duration of surgery should be taken into consideration both by spine surgeons and anesthesiologists.
俯卧位脊柱手术后的眼部并发症非常罕见，多见于长时间的择期手术。最常见的眼部并发症是视力丧失和急性闭角型青光眼。据我们所知，俯卧位脊柱手术后出现瞳孔不等大的情况此前在文献中从未有过报道。
我们报告了一例极为罕见的病例，一名23岁身体健康的女性患者，在传统俯卧位下行腰骶部脊柱骨折固定及跟骨骨折复位与外固定术后出现了短暂性、无害性的瞳孔不等大。我们逐步描述了诊断流程，并详细讨论了单侧固定性散瞳的鉴别诊断。必须通过仔细的逐步病史询问和检查来确立正确诊断，避免进行不必要、昂贵且可能有风险或侵入性的诊断检测。
俯卧位脊柱手术时的错误体位可导致虹膜括约肌撕裂以及患侧瞳孔短暂或永久性散大。固定性散瞳是虹膜的一种永久性异常，会造成不美观的外观，尤其是在年轻女性中，需要进一步的保守或手术干预。脊柱外科医生和麻醉医生都应考虑患者的体位和手术时长。
