Unilateral abnormality of initial motor-evoked potential in the upper limb detected during lumbar spine surgery: a case report

Sirima Phoowanakulchai; Hironobu Hayashi; Ayako Oi; Yasuhiro Takeshima; Tsunenori Takatani; Masahiko Kawaguchi

doi:10.1186/s40981-024-00708-1

Unilateral abnormality of initial motor-evoked potential in the upper limb detected during lumbar spine surgery: a case report

JA Clin Rep. 2024 Apr 10;10(1):23. doi: 10.1186/s40981-024-00708-1.

Authors

Sirima Phoowanakulchai¹, Hironobu Hayashi², Ayako Oi³, Yasuhiro Takeshima⁴, Tsunenori Takatani⁵, Masahiko Kawaguchi³

Affiliations

¹ Department of Anesthesiology, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand.
² Department of Anesthesiology, Nara Medical University, Kashihara, Nara, 634-8522, Japan. payashi77@hotmail.com.
³ Department of Anesthesiology, Nara Medical University, Kashihara, Nara, 634-8522, Japan.
⁴ Department of Neurosurgery, Nara Medical University, Kashihara, Nara, Japan.
⁵ Division of Central Operation, Nara Medical University Hospital, Kashihara, Nara, Japan.

Abstract

Background: We present a case with abnormal findings of initial motor-evoked potential (MEP) in the left upper limb after prone positioning during lumbar spine surgery.

Case presentation: A 71-year-old man with bilateral lower extremity numbness without a history of preexisting motor weakness underwent L3-5 spinal fenestration. Initial MEP monitoring after prone positioning revealed markedly prolonged latency and lower amplitude in the left abductor pollicis brevis (APB). Because the left upper limb somatosensory-evoked potentials had normal values, a position-related impending peripheral nerve injury located between the neck and the forearm was excluded. Postoperative examination revealed that MEP abnormality in the left APB was caused by carpal tunnel syndrome.

Conclusions: Abnormal initial MEP from the upper limb was unexpectedly detected after prone positioning during lumbar spine surgery. The condition was caused by preexisting carpal tunnel syndrome.

Keywords: Lumber spine surgery; Motor-evoked potential; Peripheral nerve injury; Prone positioning; Somatosensory-evoked potential; Train-of-four test.