case_images: PMC7210908_01
case_images: Magnetic resonance imaging of lumbosacral spine taken on the day of injury showing traumatic L3-L4 disc protrusion. L5 vertebra is sacralized.
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case_images: F1
case_images: Magnetic resonance imaging (MRI) revealed traumatic L3-L4 disc protrusion (Fig. 1).
case_images: Magnetic resonance imaging of lumbosacral spine taken after 4 months of index surgery showing recurrent disc protrusion L3-L4 with L4-L5 disc protrusion.
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case_images: F2
case_images: MRI (Fig. 2) revealed recurrence of disc protrusion at L3-L4 level along with L4-L5 disc protrusion.
case_images: Patient is positioned prone toHall's frame with adequate padding for nipples and anterior superior iliac spines. Lumbar lordosis has been obliterated. Head is supported with pillows and head ring.
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case_images: F3
case_images: With the patient placed prone to Hall's frame (Fig. 3) with head ring for the face, under general anesthesia by extending the incision over the previous scar, L4 laminectomy, pedicle screw stabilization of L3, L4, and L5 levels, discectomy at L3-L4 and L4-L5 levels, and double level transforaminal lumbar interbody fusion with cages at L3-L4 and L4-L5 levels (Fig. 4) was performed.
case_images: This picture shows discoloration and edema in the eyelids and periorbital region on the left eye.
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case_images: F5
case_images: Immediately, ophthalmologist was called over and the examination (done after 2 h) revealed periorbital edema (Fig. 5), conjunctival chemosis with erythema, and presence of pupillary reflex (along with fundoscopic findings of hazy cornea).
case_images: Pictures of optical coherence tomography recording- subretinal fluid and optic disc edema in the region of a crowded optic nerve head with a low cup:disc ratio lead to a compromise in the microvasculature resulting in posterior ischemic optic neuropathy.
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case_images: F6
case_images: As advised by the ophthalmologist, an optical coherence tomography (OCT) was done at this stage, and based on the OCT findings, diagnosis was revised as PION (Fig. 6).