Postoperative Glaucoma Decompensation Following Spine Surgery: The Importance of Proper Patient Positioning

Transforaminal lumbar interbody fusion (TLIF) is a widely utilized surgical procedure for the treatment of degenerative lumbar spinal conditions, including lumbar disc herniations, spinal stenosis, and spondylolisthesis. One such rare and underreported complication is vision loss following spinal surgery. Postoperative vision loss (POVL) is an extremely uncommon complication, occurring in approximately 0.002% to 0.2% of all non-ocular surgeries, including spinal procedures. We presented a 70-year-old male with complaints of left-sided cruralgia, lumbar radicular pain (sciatica-type L5), and right-sided weakness who underwent L4-S1 TLIF and who reported complete vision loss in his left eye, accompanied by persistent tearing from the affected eye whenever he attempted to focus his vision. The patient's vision in the left eye, which had been stable and functional prior to surgery, was permanently affected by the intraoperative complication. At the three-month follow-up, ophthalmological assessments confirmed that the optic nerve damage was irreversible, and the patient's vision in the left eye remained completely blurred. Postoperative vision loss (POVL) is a rare but devastating complication associated with various types of surgeries, including spinal procedures like transforaminal lumbar interbody fusion (TLIF). The present case of a 70-year-old patient developing permanent vision loss in his left eye due to glaucoma decompensation after TLIF underscores the importance of proper intraoperative positioning, especially in patients with pre-existing ocular conditions.