Intradural Disk Herniation at the Conus Medullaris: A Case Report With Emphasis on Patient Positioning and...

A 73-year old man who underwent previous L2-S1 decompression presenting with new right radicular leg pain. Imaging suggests a large central disk herniation at L1-2 with possible intrathecal extension requiring surgical decompression. When positioned prone on a Jackson frame, neuromonitoring motor signals became diminished, and thus, the case was aborted. On returning to the operating room 2 days later, careful positioning in a more neutral/flexed position facilitated normal neuromonitoring signals, allowing for an uneventful intradural approach and discectomy.

With conus-level intrathecal disk herniation, consider using prepositional neuromonitoring and avoid hyperextension with positioning to ensure neurological safety.