Korean J Neurotrauma.  2019 Oct;15(2):221-226. 10.13004/kjnt.2019.15.e39.

Cushing Syndrome: A Potential Risk of Bilateral Postoperative Ischemic Optic Neuropathy after Lumbar Fusion

• Park B
• Choi SW
• Han S
• Youm JY
• Lim JW
• Kwon HJ

• KMID: 2461132
• DOI: http://doi.org/10.13004/kjnt.2019.15.e39

Abstract

This is a report of a 58-year-old female with Cushing syndrome who underwent posterior lumbar fusion and lost both her vision completely. She was diagnosed with posterior ischemic optic neuropathy. Cushingoid features such as buffalo hump and central obesity might have attributed in triggering posterior ischemic optic neuropathy. When laid prone for surgery, perioperative high abdominal pressure causes venous hypertension leading to increase amount of blood loss. To compensate, infusion of large quantities of intravenous fluids is necessary which leads to hemodilution which decreases ocular perfusion pressure. Hypercoagulability of Cushing syndrome is also potentially a risk factor of this condition which increases the incidence of venous thromboembolism. For there is no known effective treatment for posterior ischemic optic neuropathy, means to prevent this complication must be strategically reviewed. When performing long spine surgery on patient who has Cushing syndrome or cushingoid features, caution must be taken to avoid this devastating complication.

Keyword

Spinal fusion; Cushing syndrome; Posterior ischemic optic neuropathy; Intraocular pressure

MeSH Terms

Buffaloes
Cushing Syndrome*
Female
Hemodilution
Humans
Hypertension
Incidence
Intraocular Pressure
Middle Aged
Obesity, Abdominal
Optic Neuropathy, Ischemic*
Perfusion
Risk Factors
Spinal Fusion
Spine
Thrombophilia
Venous Thromboembolism

Figure

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  FIGURE 1 Postoperative X-ray image showing interbody fusion and screw fixation from L1 to L5.

• 

  FIGURE 2 Fundoscopic image showing posterior ischemic optic neuropathy. Both eyes have flat and pale disc without swelling.

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  FIGURE 3 Orbit magnetic resonance imaging showing high signal intensity on the optic nerve on diffuse weighted image and diffusion restriction on apparent diffusion coefficient map.

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  FIGURE 4 Orbit magnetic resonance imaging showing mild diffuse peripheral enhancement along intraorbital segment.

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