Iatrogenic injuries are an undesired consequence of surgery, yet iatrogenic injuries to the motor system are much more devastating to a patient’s quality of life than most injuries to the sensory system. Generally an injury to the spinal cord will be most likely be picked up by somatosensory evoked potentials (SSEPs), yet a focal injury to the anterior spinal artery (ASA) may be missed [1]. There is a lot of evidence in the literature describing selective injury to the anterolateral columns sparing dorsal columns with preserved SSEPs [2–5]. The inclusions of motor evoked potentials (MEPs) to the intraoperative monitoring toolbox can help to confirm/prevent selective lesions to the anterolateral columns of the spinal cord. Yet MEPs are not without their limitations. Even with these limitations, proper application and interpretation of MEP data can be a significant adjunct in reducing iatrogenic injury during surgery.