Case Report Unilateral Blindness as a Complication of Intraoperative Positioning for Cervical Spinal Surgery Massimiliano Manfredini, Roberto Ferrante, Alessandro Gildone, and Leo Massari Department of Biomedical Sciences and Advanced Therapies, Section of Orthopaedics and Traumatology, University of Ferrara, Ferrara, Italy Summary: The authors report a case of unilateral blindness after surgical vertebral stabilization for C5–C6 subluxation. The blindness resulted from ischemia of the retina caused by prolonged compression of the eyeball on the surgical bed. This injury can be serious and irreversible, so it must be prevented by placing the patient in the proper position. The anesthetist must pay particular attention to avoid the consequences of possible intraoperative movement. Key Words: Blindness—Retinal ischemia— Intraoperative positioning. Sudden unilateral or bilateral blindness, occurring after general anesthesia, has been reported often and attributed to various causes such as hemorrhagic shock, blood dys- crasia, hypotension, hypothermia, coagulopathic disor- ders, direct trauma, and embolism (1,11). However, blind- ness as a surgical complication has rarely been described as a consequence of prolonged compression of the eyes (2,5,6,9–11). We report a clinical case of unilateral blindness caused by prolonged monocular compression in a patient having posterior vertebral stabilization for C5–C6 subluxation. CASE REPORT A 38-year-old man came to the emergency department of our hospital after being injured in an automobile acci- dent. He was experiencing pain and rigidity at the cervical spine, but he had no sign of radicular compression and only a paraesthesia in the first finger of the right hand, which disappeared completely in 3 days. Radiographic views of the cervical spine acquired im- mediately showed C5–C6 subluxation, so a Schantz collar was applied temporarily. A computed tomographic scan was performed the next day and revealed a fracture of the transverse process and of the left superior articular part of C6 with C5–C6 subluxation and no evidence of medullar compression. The patient had no other diseases, and his preoperative blood count was normal, with a hemoglobin level at 14.7 mg/dL. Surgical intervention including posterior stabilization was planned and performed 4 days after the trauma. The patient, under general anesthesia, was put on the operating table in a prone position according to the standard proce- dure. To avoid compressing his face, a semicircular pad- ded metallic device was applied to his forehead as as support. The intervention included a C4–C6 posterior wiring sta- bilization after reduction of the subluxation. Two metallic wires were inserted between the spinous process of C5 and C6 and the spinous process of C4 and C6, respectively. The total time for the intervention was 150 minutes. An- other 40 minutes was needed for the anesthesia. During the operation, no general problems, such as decrease of blood pressure or bradycardia, were encountered. The pa- tient’s postoperative hemoglobin concentration was 13.8 mg/dL. In the first postoperative period, a swelling in the left eye appeared and the patient reported complete lack of vision in the left eye. An ophthalmologic examination performed immediately revealed retinal and papilla edema. Clinical signs indicated occlusion of the central Received May 24, 1999; accepted August 26, 1999. Address correspondence and reprint requests to Dr. M. Manfredini, Via Provinciale Motta 51, Rovereto di Novi di Modena, 41030 Modena, Italy. Journal of Spinal Disorders Vol. 13, No. 3, pp. 271–272 © 2000 Lippincott Williams & Wilkins, Inc., Philadelphia 271