gms | German Medical Science

Objective: Precise patient positioning is crucial for the success of a surgical procedure in terms of both gaining adequate operative exposure and preventing potential sequelae of excessive pressure on vascular or neural structures. Patient positioning for operative procedures has been associated with perioperative complications since a long time. Although ophthalmic complications after spinal surgery are rare, they do possess potentially devastating consequences.

Methods: A 39-year-old smoking male was admitted to our hospital with low back pain and sciatica on both sides. The preoperative MRI scans demonstrated an intradural tumor below the conus medullaris at the first lumbar vertebral level measuring 10mm in diameter. The patient was classified as American Society of Anesthesiology (ASA) grade I risk by the anesthesiologists. A hemilaminectomy and total removal of the tumor was performed. Operating time was 123 minutes, the estimated blood loss was approximately 200 ml, and blood transfusion was not required during or after surgery. Intraoperative arterial blood gases and blood pressure were within normal limits. Postoperatively, the patient showed immediate blindness on the right eye. For the right eye, the diagnosis of central retinal artery occlusion was made. The patient was empirically placed on a regime of high-dose steroid therapy and reduction of blood viscosity. Carotid ultrasound and transthoracic echocardiography showed a normal state. Two months postoperatively, the ophthalmic examination showed that the right pupil was fixed and non-reactive to light; optic disc atrophy was noted in the right eye.

Conclusions: Rhabdomyolysis, abdominal compartment syndrome, brachial plexopathy, shoulder dislocation, axillary artery occlusion, venous air embolism, sensorineural hearing loss, and blindness are rare complications of the prone position. We report the case of unilateral blindness after prone position in spine surgery. The pathomorphologic cause was a central retinal artery occlusion. Nicotine was the only risk factor in our patient; during surgery, blood pressure was normally and patient position was without large excessive extraocular pressure.