Large central lumbar disc herniation causing acute cauda equina syndrome with loss of evoked potentials during prone positioning for surgery

Background Few studies in the literature discuss operative positioning for lumbar surgery precipitating acute cauda equina syndromes (CES). Case Description A 56-year-old male with a large L2-3-disc herniation was placed prone on a Jackson table. He immediately lost all motor and sensory evoked potentials. Signals returned to the baseline when surgery was aborted, and he was returned to the supine position. However, potentials were again lost when he was repositioned prone, following which the surgeons proceeded with surgical decompression with a good outcome. Conclusion This case highlights the risk for patients with large acute lumbar disc herniation/stenosis and CES undergoing prone positioning for lumbar decompression. Here, despite the secondary loss of both sensory and motor evoked potentials, the patient successfully underwent lumbar decompressive surgery/discectomy performed on a Jackson table, resulting in full postoperative neurological recovery.