Sudden hemodynamic collapse after making prone position on the Jackson spine table for spinal surgery.

A 75-year-old female patient with lumbar spinal stenosis underwent posterior lumbar spinal fusion and posterolateral interbody fusion under general anesthesia. When the patient was positioned prone on the Jackson spine table before the surgery, a sudden severe hypotension and hemodynamic collapse developed. This circulatory collapse was refractory to intravascular volume expansion, inotropes and vasopressors. Application of external abdominal support immediately restored hemodynamics. The Jackson spine table allowed the abdomen to hang freely, providing abdominal decompression as well as resulting in the severely sagged abdomen. We suspected that the sagging abdomen pulled the abdominal contents downwards kinking the inferior vena cava or caused venous pooling in the abdomen, resulting in the obstruction of venous return to the heart. The patient successfully underwent the surgery with the external abdominal support and there were no postoperative complications including abdominal compartment syndrome.