title: Neurogenic Shock Immediately following Posterior Lumbar Interbody Fusion: Report of Two Cases.
abstract: Study Design Case report. Objective To present two cases of neurogenic shock that occurred immediately following posterior lumbar interbody fusion (PLIF) and that appeared to have been caused by the vasovagal reflex after dural injury and incarceration of the cauda equina. Case Report We present two cases of neurogenic shock that occurred immediately following PLIF. One patient had bradycardia, and the other developed cardiac arrest just after closing the surgical incision and opening the drainage tube. Cardiopulmonary resuscitation was performed immediately, and the patients recovered successfully, but they showed severe motor loss after awakening. The results of laboratory data, chest X-ray, electrocardiogram, computed tomography, and echocardiography ruled out pulmonary embolism, hemorrhagic shock, and cardiogenic shock. Although the reasons for the postoperative shock were obscure, reoperation was performed to explore the cause of paralysis. At reoperation, a cerebrospinal fluid collection and the incarceration of multiple cauda equina rootlets through a small dural tear were observed. The incarcerated cauda equina rootlets were reduced, and the dural defect was closed. In both cases, the reoperation was uneventful. From the intraoperative findings at reoperation, it was thought that the pathology was neurogenic shock via the vasovagal reflex. Conclusion Incarceration of multiple cauda equina rootlets following the accidental dural tear by suction drainage caused a sudden decrease of cerebrospinal fluid pressure and traction of the cauda equina, which may have led to the vasovagal reflex.
authors.affiliation: Department of Orthopaedic Surgery, Osaka Rosai Hospital, Sakai, Osaka, Japan.
authors.forename: Tomiya
authors.initials: T
authors.lastname: Matsumoto
authors.affiliation: Department of Orthopaedic Surgery, Osaka Rosai Hospital, Sakai, Osaka, Japan.
authors.forename: Shinya
authors.initials: S
authors.lastname: Okuda
authors.affiliation: Department of Orthopaedic Surgery, Osaka Rosai Hospital, Sakai, Osaka, Japan.
authors.forename: Takamitsu
authors.initials: T
authors.lastname: Haku
authors.affiliation: Department of Orthopaedic Surgery, Bellland General Hospital, Sakai, Osaka, Japan.
authors.forename: Kazuya
authors.initials: K
authors.lastname: Maeda
authors.affiliation: Department of Orthopaedic Surgery, Osaka Rosai Hospital, Sakai, Osaka, Japan.
authors.forename: Takafumi
authors.initials: T
authors.lastname: Maeno
authors.affiliation: Department of Orthopaedic Surgery, Osaka Rosai Hospital, Sakai, Osaka, Japan.
authors.forename: Tomoya
authors.initials: T
authors.lastname: Yamashita
authors.affiliation: Department of Orthopaedic Surgery, Osaka Rosai Hospital, Sakai, Osaka, Japan.
authors.forename: Ryoji
authors.initials: R
authors.lastname: Yamasaki
authors.affiliation: Department of Orthopaedic Surgery, Bellland General Hospital, Sakai, Osaka, Japan.
authors.forename: Shigeyuki
authors.initials: S
authors.lastname: Kuratsu
authors.affiliation: Department of Orthopaedic Surgery, Osaka Rosai Hospital, Sakai, Osaka, Japan.
authors.forename: Motoki
authors.initials: M
authors.lastname: Iwasaki
keywords: bradycardia; cardiac arrest; incarceration of the cauda equine; neurogenic shock; posterior lumbar interbody fusion; spinal surgery; vasovagal reflex