Transcranial electrical stimulation motor-evoked potentials rescue from postoperative neurological deficit due to inadequate neck position for the case of lumbar surgery with asymptomatic cervical stenosis.

Abstract

Transcranial electrical stimulation motor-evoked potentials (TES-MEPs) are an intraoperative neurophysiologic monitoring method that reduces adverse outcomes in various spine surgeries. Although spine surgeons rarely use TES-MEPs for simple lumbar decompression surgery, we herein firstly report the efficacy of TES-MEPs for lumbar spinal canal stenosis with asymptomatic coexisting cervical canal stenosis. We report the case of a 71-year-old man who underwent lumbar decompression surgery for lumbar spinal canal stenosis. He had asymptomatic cervical spinal canal stenosis before surgery. TES-MEPs showed apparent derivation failure of wave amplitudes from the upper and lower limb muscles immediately after posture change from supine to prone for operative preparation. The cervical alignment was corrected. Subsequently, the TES-MEP wave amplitudes became derivable immediately. While TES-MEPs can be used to prevent neurological deficits in lumbar spine surgery, it can also be used to indirectly monitor other spinal lesions. Based on our experience, we recommend using TES-MEPs even in lumbar spine surgery.