Background: While spine surgeries like Transforaminal Lumbar Interbody Fusion (TLIF) are routine for degenerative lumbar conditions, they carry a rare but devastating risk of perioperative cerebrovascular accident, with an incidence of 0.05% to 0.22%. Postoperative visual loss is commonly attributed to ischemic optic neuropathy mainly due to pressure to the eyes on a prone position; however, cortical blindness from occipital lobe infarction is an emerging rarity that can mimic these symptoms.

Case Presentation: A 57-year-old female with multi-level herniated nucleus pulposus and Hypertension, stage II presented with progressive radiculopathy. Following the spine surgery, the study investigates granular variables including prone positioning, hemodynamic fluctuations, and anesthetic management that may have precipitated a cerebrovascular accident.

Objective: This study aims to characterize cerebrovascular accident as a primary differential diagnosis for postoperative visual disturbances, and to propose a pathophysiological mechanism linking lumbar surgery to cranial ischemic events.

Methods: This research utilizes a two-phase evidence synthesis model. Phase I involves a retrospective review of a pilot index case at East Avenue Medical Center. Phase II uses variables from the pilot case to conduct a systematic review of global literature published between 2011 and 2026.

Conclusion: It is important to be aware of the various etiologies of perioperative blindness after spine surgery. Proper knowledge of risk factors, pathomechanisms, prompt diagnostic work-up, and multidisciplinary treatment may be vital in avoiding such devastating complications. This paper described a rare but significant complication following lumbar spine surgery; i.e., occipital lobe infarction and provides an algorithm to distinguish from other differentials.