Postoperative Blindness Due to Posterior Reversible Encephalopathy Syndrome Following Spine Surgery: A Case Report and Review of the Literature.

Abstract

Spine surgery is the leading cause of postoperative visual loss; the incidence has been reported to be as high as 0.20%1. The most common etiologies include ischemic optic neuropathy (ION), central retinal vascular occlusion, or a posterior cerebral infarction2. We describe a case of posterior reversible encephalopathy syndrome (PRES) that caused an acute onset of blindness following spinal deformity surgery in an adult. We also provide a review of the literature on PRES and various treatment strategies. The patient was informed that data concerning the case would be submitted for publication, and she provided consent. A fifty-six-year-old woman with a complex multiplanar thoracolumbar spinal deformity presented to our tertiary care spine center with severe back pain that was not responsive to conservative management (Figs. 1-A and 1-B). After careful review of the risks and benefits of surgery with the patient, she was scheduled for a three-stage instrumented fusion from T3 to the pelvis. The past medical history was noteworthy for well-controlled hypertension, hypothyroidism, and a lacunar cerebrovascular accident, which had caused transient aphasia and facial numbness fifteen years prior. Preoperative anteroposterior ( Fig. 1-A ) and lateral ( Fig. 1-B) full spine radiographs show a left lumbar degenerative scoliosis apex curve (Cobb angle, 85°), a right adolescent scoliosis apex curve (Cobb angle, 70°), and a coronal imbalance of 1.6 cm to the right. Fig. 1-A Fig. 1-B The three-stage surgical procedure was scheduled to be completed consecutively over one day. The first stage was an anterior lumbar fusion of L4-L5 and L5-S1; the second stage was the placement of extreme lateral interbody fusions of L2-L3 and L3-L4; and the third stage was a posterior spinal fusion from T3 to the pelvis. The first two stages of the surgery proceeded uneventfully. During the third stage, after bilateral iliac bolts had been placed, facetectomies had been completed from L1-S1, and pedicle screws had been placed from L1-S1, it was noted that the patient’s cumulative blood loss from the three procedures was substantial. The decision was made to place temporary fixation from L1 to the pelvis and …