The patient was operated by me several times for gun shoot to the cauda equina the first was 19-April-2009. The patient showed slight improvement of the left leg, but the right showed gradual deterioration of dorsiflexion big toe with agonizing pain the last month at the trajectory of the right peroneal nerve with the appearance of looking-like painful neuroma. Upon touching it it was firing down and the patient was twice injected transcoccegeally with Diprofos and marcain, thinking that the source of pain is from the cauda equina.

The right peroneal nerve was exposed proximal to the lesion and neurolysis was continued down until the nerve was branching to its deep and superficial parts. Using IOM Inomed ISIS with 2 channel EMG and DNS cc stimulation during the procedure the nerve regained better responses after neurolysis and the EMG traces were recorded even in less than 1 mA stimulation. he painful neuroma turned to be a scar engulfing the nerve and it was bisected during neurolysis.

Routine closure of the wound and smooth postoperative recovery and the patient sent to the ward.

This case with multiple neurological trauma and direct trauma to the right knee is a difficult case to catch the entrapment, which progressed over the time.

During such a surgery neurophysiological control with Inomed ISIS or alike technologies, the surgeon could reach wrong conclusions and perform wrong actions subsequently.