Türk Nöroşirürji Dergisi
2009 , Vol 19 , Num 2
A Rare Complication in a Patient Subjected to Long Segment Spinal Instrumentation: Partial Visual Loss and Diplopia
1,2,3,6Ankara Numune Eğitim ve Araştırma Hastanesi, 2. Nöroşirürji Kliniği, Ankara, Türkiye4Ankara Numune Eğitim ve Araştırma Hastanesi, Anestezi Kliniği, Ankara, Türkiye
5Ankara Numune Eğitim ve Araştırma Hastanesi, 1. Radyoloji Kliniği, Ankara, Türkiye Visual problems after spinal surgery particularly lasting longer than 2 hours are uncommon. Among the most important risk factors, patient based factors like anemia, hypertension and cigarette smoking, systemic problems like intraoperative hypotension and hypovolemia, massive hemorrhage and blood transfusion or mechanical problems like ocular compression or inappropriate positioning are more common. We present a 59 year old woman who experienced clouding of vision and diplopia on the second postoperative day after being subjected to a 5 segment decompression and posterior lumbar pedicular fixation. Signs of acute ischemia in the upper pons and lower mesencephalon on the right were prominent on cranial and diffusion weighted MRI. Seven units of blood were transfused to the patient at the preoperative and postoperative period who had a preoperative Hb value of 11.1 gr/dL and lowest level of 6.6 gr/dL. After blood transfusion, hemoglobin level rised to a level of 10.4 gr/dL and all symptoms exacerbated on the fourth postoperative day. Patients who are candidates for a long segment spinal surgery should be carefully sought for the presence of risk factors at the preoperative period. Parameters regarding treatment should be explored although visual problems rarely develop after surgery despite all precautions. Anahtar Kelimeler : Anemia, Complication, Diplopia, Pontine ischemia, Spinal instrumentation, Visual loss