Myers M A, Hamilton S R, Bogosian A J, Smith C H, Wagner T A
Orthopedic Physician Associates, Seattle, Washington, USA.
Spine (Phila Pa 1976). 1997 Jun 15;22(12):1325-9. doi: 10.1097/00007632-199706150-00009.
Thirty-seven patients who experienced visual loss after spine surgery were identified through a survey of the members of the Scoliosis Research Society and a review of the recent literature.
Records were reviewed in an attempt to identify preoperative and intraoperative risk factors and to assess the likelihood of recovery.
Postoperative blindness after spine surgery has been documented in case reports or small series. The authors report the largest group of such cases to date and the first to allow conclusions regarding risk and prognosis.
Letters were sent to members of the Scoliosis Research Society requesting copies of medical records concerning patients who experienced postoperative visual deficits after spine surgery. An additional 10 well-documented recent cases were identified from published reports.
Patients with visual loss had a mean age of 46.5 years. Surgery included instrumented posterior fusion in 92% of the cases, with an average operative time of 410 minutes and blood loss of 3500 mL. Most cases had significant intraoperative hypotension, with a mean drop in systolic blood pressure from 130 to 77 mm Hg. However, comparison with a matched group of patients with no visual symptoms showed no differences in the hematocrit or blood pressure values. Visual loss occurred because of ischemic optic neuropathy, retinal artery occlusion, or cerebral ischemia. Eleven cases were bilateral, and 15 patients had complete blindness in at least one eye. Most deficits were permanent.
The authors conclude that blindness after spine surgery is more common than has been recognized previously. Most cases are associated with complex instrumented fusions.
通过对脊柱侧弯研究学会成员的调查以及近期文献回顾，确定了37例脊柱手术后出现视力丧失的患者。
回顾病历，试图找出术前和术中的危险因素，并评估恢复的可能性。
脊柱手术后失明已在病例报告或小系列研究中有记载。作者报告了迄今为止此类病例中最大的一组，并首次得出有关风险和预后的结论。
向脊柱侧弯研究学会成员发送信件，索要脊柱手术后出现视力缺损患者的病历副本。从已发表的报告中又确定了另外10例记录详尽的近期病例。
视力丧失患者的平均年龄为46.5岁。92%的病例手术包括后路器械融合，平均手术时间为410分钟，失血量为3500毫升。大多数病例术中出现明显低血压，收缩压平均从130毫米汞柱降至77毫米汞柱。然而，与一组无视力症状的匹配患者相比，血细胞比容或血压值并无差异。视力丧失是由于缺血性视神经病变、视网膜动脉阻塞或脑缺血所致。11例为双侧，15例患者至少一只眼睛完全失明。大多数视力缺损是永久性的。
作者得出结论，脊柱手术后失明比之前认为的更为常见。大多数病例与复杂的器械融合有关。
