Unilateral Blindness as a Complication of Spinal Surgery: A Case Report

一位五十八歲男性病患，因第四腰椎至第一薦椎間關節退化，並合併椎管狹窄及神經壓迫症狀，於民國八十七年七月接受脊椎後方減壓、後融合及脊椎內固定手術，而術後產生右眼失明之併發症。經過一系列之神經學及眼科檢查，發現其為右眼之中央視網膜動脈阻塞，根據文獻記載，造成脊椎手術後失明併發症之因數很多，包括直接損傷、血液疾病、術中出血性低血壓、低體溫麻醉及極少數之眼球直接壓迫引起，而術前亦需考量之危險因子，包括高血壓、糖尿病、吸菸及血管方面之疾病。而此患者，根究其原因，發現除術前糖尿病及吸菸之危險因子外，在時間過長之手術中，右眼球之直接壓迫為造成右眼中央視網膜動脈阻塞之最重要原因。因此手術者必須謹慎評估病患手術前之各項危險因素，並確認手術時病患之姿勢，避免一切增加眼球壓力之外在因素，謹慎運用低體溫及低血壓之全身麻醉，以避免此一嚴重之併發症。

關鍵字

失明；脊椎手術

並列摘要

Unilateral visual loss complicating spinal surgery has been reported and attributed to multiple causes including direct trauma, hemorrhagic hypotension, blood dyscrasias, coagulopathies, hypotension, hypothermia, embolism, and rarely direct pressure on the globe. Many preoperative risk factors such as hypertension, cigarette smoking, diabetes and vascular diseases have been ascribed to the unusual ocurrence of this complication of spinal surgery^(1.2.3.4). A 58-year-old male presented with degenerative spinal stenosis of L4 to S1 underwent surgical procedure due to persistence of symptoms and signs after prolonged conservative management. Posterior decompression, posterolateral fusion and posterior instrumentation with Isolar device were performed under general anesthesia. Unilateral blindness was noted immediately postoperatively. Series of neurological and ophthalmologic studies revealed central retinal artery occlusion as the cause of this complication. In turn, systemic survey indicates a combination of risk factors of DM, cigarette smoking, and perhaps most importantly the direct pressure on the affected eye during prolonged surgical procedure contributed to the arterial occlusion.

並列關鍵字

blindness ； spinal surgery

國際替代計量

Unilateral Blindness as a Complication of Spinal Surgery: A Case Report

全文下載

主題瀏覽