{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,13]],"date-time":"2026-04-13T16:06:45Z","timestamp":1776096405184,"version":"3.50.1"},"reference-count":34,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"13","license":[{"start":{"date-parts":[[2026,3,30]],"date-time":"2026-03-30T00:00:00Z","timestamp":1774828800000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J Neurosurg Case Lessons"],"published-print":{"date-parts":[[2026,3,30]]},"abstract":"<jats:sec>\n                    <jats:title>BACKGROUND<\/jats:title>\n                    <jats:p>Intraoperative neuromonitoring (IONM) is primarily used to prevent irreversible motor deficits during spinal surgery. However, the prognostic significance of intraoperative waveform recovery\u2014particularly its correlation with postoperative neurological improvement\u2014remains controversial. The authors report a rare case of cervical spontaneous spinal epidural hematoma in which motor evoked potentials (MEPs) were absent at baseline but recovered following surgical decompression.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>OBSERVATIONS<\/jats:title>\n                    <jats:p>Reports describing the emergence of MEP waveforms after complete baseline absence are extremely limited. In the present case, the short interval between symptom onset and surgical intervention, along with the nontraumatic nature of the injury, likely minimized direct spinal cord damage, thereby permitting waveform recovery after decompression. Previous studies have suggested that improvement in MEP amplitude is associated with favorable neurological outcomes, and the appearance of MEPs in this case may reflect the functional efficacy of decompression.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>LESSONS<\/jats:title>\n                    <jats:p>Even in the absence of baseline MEP responses, the intraoperative emergence of waveforms may serve as an indicator of effective decompression. These findings support the continued use of IONM during surgery, as it may provide valuable real-time prognostic information.<\/jats:p>\n                    <jats:p>\n                      <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"uri\" xlink:href=\"https:\/\/thejns.org\/doi\/10.3171\/CASE251007\">https:\/\/thejns.org\/doi\/10.3171\/CASE251007<\/jats:ext-link>\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.3171\/case251007","type":"journal-article","created":{"date-parts":[[2026,4,8]],"date-time":"2026-04-08T10:04:31Z","timestamp":1775642671000},"source":"Crossref","is-referenced-by-count":0,"title":["Temporal recovery in motor evoked potential during evacuation of cervical spontaneous epidural hematoma: illustrative case"],"prefix":"10.3171","volume":"11","author":[{"given":"Ryuta","family":"Matsuoka","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, Nara Medical University, Kashihara, Nara"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yasuhiro","family":"Takeshima","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Nara Medical University, Kashihara, Nara"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6242-056X","authenticated-orcid":true,"given":"Tsunenori","family":"Takatani","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, Nara Medical University, Kashihara, Nara"},{"name":"Department of Operation Center, Nara Medical University Hospital, Kashihara, Nara, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yudai","family":"Morisaki","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Nara Medical University, Kashihara, Nara"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tae-Kyun","family":"Kim","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Nara Medical University, Kashihara, Nara"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shohei","family":"Yokoyama","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Nara Medical University, Kashihara, Nara"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hironobu","family":"Hayashi","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, Nara Medical University, Kashihara, Nara"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0307-3657","authenticated-orcid":true,"given":"Ryosuke","family":"Matsuda","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Nara Medical University, Kashihara, Nara"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Young-Soo","family":"Park","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Nara Medical University, Kashihara, Nara"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Masahiko","family":"Kawaguchi","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, Nara Medical University, Kashihara, Nara"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1340-3293","authenticated-orcid":true,"given":"Ichiro","family":"Nakagawa","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Nara Medical University, Kashihara, Nara"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1754","reference":[{"issue":"5762","key":"bib1","series-title":"Nature","first-page":"227","article-title":"Stimulation of the cerebral cortex in the intact human subject","volume":"285","author":"Merton","year":"1980","unstructured":"Merton PAMorton HB.Stimulation of the cerebral cortex in the intact human subject. Nature. 1980;285(5762):227. doi:10.1038\/285227a0"},{"issue":"2","key":"bib2","series-title":"Neurosurgery","first-page":"219","article-title":"Modification of cortical stimulation for motor evoked potentials under general anesthesia: technical description","volume":"32","author":"Taniguchi","year":"1993","unstructured":"Taniguchi MCedzich CSchramm J.Modification of cortical stimulation for motor evoked potentials under general anesthesia: technical description. Neurosurgery. 1993;32(2):219-226. doi:10.1227\/00006123-199302000-00011"},{"issue":"3 suppl","key":"bib3","series-title":"Global Spine J","first-page":"105S","article-title":"Accuracy of intraoperative neuromonitoring in the diagnosis of intraoperative neurological decline in the setting of spinal surgery-a systematic review and meta-analysis","volume":"14","author":"Alvi","year":"2024","unstructured":"Alvi MAKwon BKHejrati NAccuracy of intraoperative neuromonitoring in the diagnosis of intraoperative neurological decline in the setting of spinal surgery-a systematic review and meta-analysis. Global Spine J. 2024;14(3 suppl):105S-149S. doi:10.1177\/21925682231196514"},{"issue":"1","key":"bib4","series-title":"J Spine Surg","first-page":"58","article-title":"Spontaneous spinal epidural hematoma: literature review","volume":"3","author":"Figueroa","year":"2017","unstructured":"Figueroa JDeVine JG.Spontaneous spinal epidural hematoma: literature review. J Spine Surg. 2017;3(1):58-63. doi:10.21037\/jss.2017.02.04"},{"issue":"6","key":"bib5","series-title":"Eur Spine J","first-page":"1875","article-title":"Prognostic value of intraoperative MEP signal improvement during surgical treatment of cervical compressive myelopathy","volume":"25","author":"Wang","year":"2016","unstructured":"Wang STian YWang CPrognostic value of intraoperative MEP signal improvement during surgical treatment of cervical compressive myelopathy. Eur Spine J. 2016;25(6):1875-1880. doi:10.1007\/s00586-016-4477-5"},{"issue":"1","key":"bib6","series-title":"J Spine Surg","first-page":"86","article-title":"Do intra-operative neurophysiological changes predict functional outcome following decompressive surgery for lumbar spinal stenosis? 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Spine (Phila Pa 1976). 2008;33(26):E994-E1000. doi:10.1097\/brs.0b013e318188adfc"},{"issue":"10","key":"bib13","series-title":"Spine J","first-page":"1472","article-title":"Higher success rate with transcranial electrical stimulation of motor-evoked potentials using constant-voltage stimulation compared with constant-current stimulation in patients undergoing spinal surgery","volume":"17","author":"Shigematsu","year":"2017","unstructured":"Shigematsu HKawaguchi MHayashi HHigher success rate with transcranial electrical stimulation of motor-evoked potentials using constant-voltage stimulation compared with constant-current stimulation in patients undergoing spinal surgery. Spine J. 2017;17(10):1472-1479. doi:10.1016\/j.spinee.2017.05.004"},{"issue":"9","key":"bib14","series-title":"Spine J","first-page":"1635","article-title":"Which patients do we need to consider augmentation of muscle active potentials regarding transcranial electrical stimulation motor-evoked potentials monitoring before spine surgery?","volume":"24","author":"Mui","year":"2024","unstructured":"Mui TShigematsu HTakatani TWhich patients do we need to consider augmentation of muscle active potentials regarding transcranial electrical stimulation motor-evoked potentials monitoring before spine surgery? Spine J. 2024;24(9):1635-1644. doi:10.1016\/j.spinee.2024.04.015"},{"issue":"6","key":"bib15","series-title":"Br J Neurosurg","first-page":"712","article-title":"Spinal epidural haematoma; factors influencing outcome","volume":"27","author":"Mukerji","year":"2013","unstructured":"Mukerji NTodd N.Spinal epidural haematoma; factors influencing outcome. 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A prospective study","volume":"4","author":"Piasecki","year":"2018","unstructured":"Piasecki KKulik GPierzchala KPralong ERao PJSchizas C.Do intra-operative neurophysiological changes predict functional outcome following decompressive surgery for lumbar spinal stenosis? A prospective study. J Spine Surg. 2018;4(1):86-92. doi:10.21037\/jss.2018.03.05"},{"issue":"1","key":"bib7","series-title":"Asian Spine J","first-page":"79","article-title":"Clinical significance of improved intraoperative neurophysiological monitoring signal during spine surgery: a retrospective study of a single-institution prospective cohort","volume":"14","author":"Wi","year":"2020","unstructured":"Wi SMLee HJKang TClinical significance of improved intraoperative neurophysiological monitoring signal during spine surgery: a retrospective study of a single-institution prospective cohort. 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Spine (Phila Pa 1976). 2008;33(26):E994-E1000. doi:10.1097\/brs.0b013e318188adfc"},{"issue":"10","key":"bib13","series-title":"Spine J","first-page":"1472","article-title":"Higher success rate with transcranial electrical stimulation of motor-evoked potentials using constant-voltage stimulation compared with constant-current stimulation in patients undergoing spinal surgery","volume":"17","author":"Shigematsu","year":"2017","unstructured":"Shigematsu HKawaguchi MHayashi HHigher success rate with transcranial electrical stimulation of motor-evoked potentials using constant-voltage stimulation compared with constant-current stimulation in patients undergoing spinal surgery. 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