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. 2024 Dec 6;41(1):37. doi: 10.1007/s00381-024-06673-5

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© The Author(s) 2024

Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.

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Fig. 5 — Schematic illustration of IOM responses to the threshold- and the double-train stimulation method in sensory (dorsal) and motor (ventral) nerve roots (blue color sensory neuron, green color interneuron, and orange color motor neuron). Upper row (A and B): “threshold method” in unaffected roots: (A) indicates a longer latency and lower amplitude with higher current (▲) stimulation compared to motor root stimulation (B). Middle row: “threshold method” in the presence of a lipoma: (C) and (D) demonstrate a requirement for higher stimulation intensity (▲), resulting in longer latency and reduced amplitude in comparison to stimulation of an unaffected motor root. The response from motor root stimulation (D) might be nearly identical to that for a sensory root stimulation (A) in an unaffected root. Lower row: “double-train method” in the presence of a lipoma: The first response in (E) and (F) is similar. After the second pulse train, only the motor root (F) shows a second EMG response. No second EMG response is elicited after stimulation of the sensory root, due to the longer recovery time (details in the text). ▲ = current intensity of the stimulus (bigger triangle = higher intensity)