Blindness As A Result of Spinal Surgery
It may seem extraordinary, but blindness can result from surgery that is not related directly to either the head or the brain. Post-operative blindness that is not due to ocular surgery is most often related to surgery of the spine.
Post-operative blindness
Blindness as a result of spinal surgery is a rare occurrence but can happen in a variety of ways and, apart from ocular surgery, is one of the most common causes of post-surgical blindness. As the number of spinal operations increases, there is a risk of a rise in the incidence of post-operative blindness.
Awareness of the risk and likely influencing factors is, therefore, vital in order to ensure the consideration of preventative measures, monitoring and prompt response to signs of visual impairment.
Depending on the type of damage, the visual loss can be total or partial, temporary or permanent and unilateral (one-sided) or bilateral (affecting both eyes).
Causes of loss of vision due to spinal surgery
The eye and its related structures are extremely complex and vulnerable to various types of damage, all of which can impact on the effectiveness of vision. Blindness developing after spinal surgery has been reported due to a range of causes:
Ischemic optic neuropathy
Ischemic optic neuropathy (ION) is the most commonly-reported cause of post-operative blindness. It occurs when the blood flow to the optic nerve is restricted, thus reducing the delivery of oxygen to the nerve. This can lead to cell damage in the nerve and loss of function. ION is most likely to produce permanent loss of vision, either unilaterally or bilaterally, although there have been occasional reports of recovery.
The optic nerve carries information from the retina at the back of the eye to the brain where those messages are interpreted to produce the images we experience. If the optic nerve cannot function due to cell death, messages from the eye will not reach the brain. As a result, although the eye itself is not damaged, the brain cannot receive the messages which enter the eye.
Blindness due to ION is likely to be painless and the patient is initially likely to experience blurred vision on coming round from a general anaesthetic.
Retinal Ischemia
The retina is found at the back of the eye and receives the light impulses which travel through the cornea and pupil at the front of the eye before relaying those messages on to the optic nerve. The retina relies on a constant blood supply through the central retinal artery in order to function effectively. If this blood flow is blocked or restricted the patient is likely to experience painless loss of vision in one eye.
Such an injury can be caused by inappropriate pressure being applied to the eye thus restricting the functioning of the artery.
Cortical blindness
Cortical blindness can occur when the visual cortex within the brain is damaged, meaning that messages received from the eye via the optic nerve cannot be interpreted. This can happen due to a variety of causes during surgery related to blood flow and pressure. This can lead to profound, total, bilateral loss of vision even though the eye itself is not damaged.
Acute glaucoma
Acute glaucoma results from events within the eye where fluid pressure increases. It can cause sudden blindness and is regarded as an emergency. This is a rare occurrence. The patient is likely to experience pain and blurred vision, possibly with nausea and vomiting.
How does spinal surgery cause visual impairment?
Post-operative blindness following spinal surgery has been associated with a number of factors, the most common of which are the following:
- The patient being placed in the prone position (face down)
- Improper positioning or inappropriate use of head supports
- A prolonged operation
- The use of general anaesthetic
- Excessive blood loss
Who is most at risk?
Although not definite, there may be some pre-existing conditions that put some patients at greater risk of developing loss of vision after spinal surgery. These conditions include the following:
- High blood pressure
- Anaemia
- Obesity
- Male gender
- Being a smoker
- Being diabetic
Although the risk of post-operative blindness is very small, there is an argument that those patients who are considered to be at a slightly higher risk should be warned of this possibility when being asked to consent to surgery.
Prevention and monitoring
As suggested by the factors mentioned earlier, awareness of the possible impact of the positioning of the patient in spinal surgery is key to prevention of this devastating development. The use of headrests when the patient is in the prone position appears to be controversial.
Monitoring of the patient during surgery in terms of visual responses as well as blood pressure and blood loss is advised.
Where a patient has already been identified as at a high risk of post-operative blindness, their visual responses should be assessed immediately upon recovery from the general anaesthetic.
Treatment
Where any impact on the patient's vision is suspected, a specialist ophthalmologist should be consulted immediately.
Treatment will depend on what is thought to be the underlying cause of the loss of vision, although in some cases, the best form of treatment is unclear.
Medical Negligence
As effective treatment may not be available, awareness of the risk factors and taking preventative measures may be the best solutions to the problem of visual loss due to spinal surgery.
Where pre-existing factors have not been taken into account and recommendations for good practice ignored, the patient who is unfortunate enough to suffer this devastating, and sometimes permanent, outcome of surgery may have been the victim of medical negligence.
Contact Glynns Solicitors to discuss the circumstances of your case. We are a team of specialist medical negligence solicitors who can advise you whether you may be in a position to make a claim for compensation.
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