title: Dural Traction a Possible Cause of Hemodynamic Changes During Single-Level Transforaminal Lumbar Interbody Fusion.
abstract: BACKGROUND
  Lumbar spinal surgery may be associated with electrophysiologic and hemodynamic abnormalities during the procedure.
  
  
  METHODS
  A 58-year-old man with grade II L4-5 spondylolisthesis and degenerative changes underwent single-level transforaminal lumbar interbody fusion. During decompression of the L4 foramina, distraction of the disc space, and placement of the interbody cage and pedicle screws, episodes of extreme bradycardia with up to 5 seconds of asystole were detected on electrocardiogram and invasive hemodynamic monitoring. The events correlated with and possibly could have been a result of traction on the dura mater.
  
  
  CONCLUSIONS
  Anesthesia providers should be aware of electrophysiologic and hemodynamic abnormalities during lumbar spinal surgery and the need to respond appropriately with sympathomimetic or vagolytic interventions.
authors.affiliation: Department of Internal Medicine, Cleveland Clinic, Cleveland, Ohio, USA.
authors.forename: Jonathan M
authors.initials: JM
authors.lastname: Weimer
authors.affiliation: Department of Anesthesiology, Perioperative Medicine and General Intensive Care, Salzburg University Hospital, Paracelsus Medical University, Salzburg, Austria.
authors.forename: Martin
authors.initials: M
authors.lastname: Marinov
authors.affiliation: Department of General Anesthesiology, Cleveland Clinic, Cleveland, Ohio, USA. Electronic address: avitsir@ccf.org.
authors.forename: Rafi
authors.initials: R
authors.lastname: Avitsian
mesh_terms: D004388:Dura Mater / Q000000981:diagnostic imaging / Q000601:surgery*; D004562:Electrocardiography / Q000639:trends; D006439:Hemodynamics / Q000502:physiology*; D006801:Humans; D007431:Intraoperative Complications / Q000000981:diagnostic imaging / Q000209:etiology / Q000503:physiopathology; D008159:Lumbar Vertebrae / Q000000981:diagnostic imaging / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D013123:Spinal Fusion / Q000009:adverse effects*; D014143:Traction / Q000009:adverse effects*
keywords: Asystole; Dural traction; Lumbar interbody fusion