Severe hypotension during vertebral derotation in surgical correction of scoliosis

Hypotension event in intraoperative settings may cause postoperative morbidity in surgical correction of scoliosis. Most often complications of intraoperative hypotension are postoperative ischemic optic neuropathy and postoperative ischemic stroke due to global hypoperfusion. Hypovolemic shock due to bleeding or blood loss is the most common cause of intraoperative hypotension in surgical correction of scoliosis. However, bleeding is not only the main cause of hypotension. A young female underwent surgical correction of scoliosis, during the operation she had a sudden and rapid decrease of blood pressure (BP) but then rapidly improved after the surgeon stopped the surgery which was a de-rotational procedure. Neurogenic shock is one of the complications that may occur during the manipulation of the spinal cord which is marked by a sudden and rapid decrease of BP and usually accompanied by bradycardia due to sudden and rapid loss of autonomic tone. Hypotension in neurogenic shock usually is refractory hypotension which cannot be treated only with fluid resuscitation but also needs vasopressor, thus this neurogenic shock should get immediate and prompt treatment to avoid further complications.