The patient came to the clinic 17-May-2007 complaining of LBP with difficulty to walk and failed sacral functions. The patient was operated elsewhere 1986 for cyst at T12-L1 level, but dripping of urine took place. The patient was reoperated elsewhere 2003 after further deterioration with numb both legs, more the right. The patient claim that the last 2 months got deterioration with inability to climb a stair.
MRI performed 14-February-2007 showing huge recurrence of the lesion

On examination: SLRS was 30 degrees in both sides due to weakness with KJ negative in the left and absent both AJ. He has hypalgesia for pin-brick 15 cm above the umbilicus right side and at the level of the knee in the left leg. The right quadriceps was 3/5 and the left was 4/5 with adduction both knees 2/3 and adduction 3/5 both sides. Planter and dorsiflexion both feet were 3/5 more prominent in the right with slight atrophy of the right foreleg. There was no control upon defecation and micturition.

Using ISIS Inomed Highline IOM with lumbar tumor scenario, it was detected that the FSR3 and MEP and SEP were unable to obtain readings for the anal sphincteric activity, nor the dorsal branches of the penis were able to be detected. Mr. Dietmar Benz the Dipl. eng of Medizintechnick of Inomed was performing the IOM. Even the BCR was unable to obtain. The other parameters were acceptable and with best results emerging from the right tibialis. The dura was full of scar and the upper border of the lesion was attacked. Under the guidance of the bipolar stimulation, longitudinal incision was performed over the upper pole of the lesion. Around 10 mm longitudinal incision was made to evacuate and remove the pearl-like material of the epidermoid. Further loculations of the epidermoid were sought and removed. Stimulation of the running roots showed slight improvement of the curves with decrease of latency and increase of the amplitude. Investigation of the sacral functions after the completion of the tumor removal did not show any signs of recovery.
Meticulous cleaning of the spaces and the scarous arachnoids around the roots ruled out presence of any remnant of the tumor.
Water-tight closure of the dura and the wound.
Smooth postoperative recovery, with improvement of the power of both feet.

It is the third operation for the same level with scars masking the normal anatomy. Without the guidance of the IOM it was impossible to know what exactly the importance of the abnormally localized neural structures.

It was evident that the motor functions of L-2-3-4 and L5 were showing improvement in the records, because of the decompression.

It was sad that the BCR, anal-M-wave, MEP and SEP after pudendal stimulation and the D-wave did not show any signs of the sacral functions before and after the surgery.