Dural Traction a Possible Cause of Hemodynamic Changes During Single-Level Transforaminal Lumbar Interbody Fusion

Acute recurrent bradycardia with evoked potential loss during transforaminal lumbar interbody fusion

“…The intermittent bradycardia that occurred during insertion of the expandable cage is rare but consistent with previously reported cases [2,3,5]. However, none of the aforementioned reports noted decrements in intra-operative neuromonitoring or an associated postoperative neuropraxia.…”

“…A knowledgeable and observant anaesthetist is therefore crucial to providing an early declaration of anatomical trespass and impending injury. The intermittent bradycardia that occurred during insertion of the expandable cage is rare but consistent with previously reported cases [2, 3, 5]. However, none of the aforementioned reports noted decrements in intra‐operative neuromonitoring or an associated postoperative neuropraxia.…”

“…We present a case where we observed intermittent bradycardia directly associated with surgical manoeuvres followed by critical changes in somatosensory evoked potentials. There are several reports of severe bradycardia or asystole during intervertebral disc space distraction and placement of an expandable interbody cage [2][3][4][5]. However, we present the first case in which severe bradycardia and subsequent somatosensory evoked potential decrement was noted.…”

Hemodynamically significant cardiac arrhythmias during general anesthesia for spine surgery: A case series and literature review

“…Previous case reports suggested bradycardia during spine surgery is caused via afferent parasympathetic stimulation during dural traction or electrocautery in the lumbosacral region [10] , [11] , [12] , [13] , [14] , [15] . A lumbar-cardiac reflex has been proposed, in which parasympathetic stimulation leads to increased vagal tone, and consequent bradycardia and hypotension [ 16 , 17 ].…”