N24 spinal response to tibial nerve stimulation and magnetic resonance imaging in lesions of the lumbosacral spinal cord

We studied tibial nerve somatosensory evoked potentials (SEPs) in 22 patients with progressive clinical signs of sensory and motor involvement of the lower limbs. Magnetic resonance imaging (MRI) in 21 patients revealed lesions of the thoracolumbar cord in 18 and of the cauda equina in the remaining three. SEP recordings enabled us to clearly differentiate the response generated by the dorsal horns of the lumbosacral cord from the activity generated in the cauda equina dorsal roots. Neurophysiologic findings strongly correlated with the lesion site demonstrated by the MRI (cauda equina, lumbosacral cord, or thoracic cord immediately above the lumbar enlargement). The N24 cord potential was absent with a normal cauda equina response in 10 of 12 patients with MRI signs of lumbosacral cord lesions. Clinical examination often failed to localize the spinal cord as the lesion site, suggesting pure peripheral involvement in six of the 12 patients with MRI signs of lumbosacral cord lesions.