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Related Experiment Video

Updated: Apr 4, 2026

An Anatomical Study of Nerves at Risk During Minimally Invasive Hallux Valgus Surgery
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Intraoperative Lower Extremity SSEP Absence from Over-Tightened Safety Strap: Case Report.

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  • 1Seastnan Medical, LLC, Overland Park, Kansas, USA.

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|April 3, 2026
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Summary

Excessively tight safety straps during spinal surgery can cause neurological dysfunction, leading to abnormal somatosensory evoked potentials (SSEPs) in lower extremities. Promptly loosening the strap restored normal SSEP function, highlighting patient positioning importance.

Keywords:
LumbarSSEPneuromonitoringpositioningspine surgery

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Area of Science:

  • Neurosurgery
  • Neurology
  • Spinal Cord Monitoring

Background:

  • Somatosensory evoked potentials (SSEPs) are crucial for monitoring dorsal column medial lemniscal pathway integrity during spinal surgeries.
  • Waveform amplitude changes in SSEPs can result from surgical actions or external factors, complicating interpretation.

Purpose of the Study:

  • To report a case of bilateral lower extremity SSEP deterioration during spinal surgery.
  • To identify an external factor, specifically patient positioning and restraint application, as the cause of SSEP changes.

Main Methods:

  • Intraoperative neuromonitoring (IONM) using lower extremity SSEPs was performed during a posterior lumbar decompression/fusion.
  • Patient positioning and the application of external restraints, including a safety strap, were carefully reviewed.

Main Results:

  • Bilateral lower extremity SSEP amplitudes deteriorated significantly during the procedure.
  • The SSEP changes were directly attributed to an excessively tight safety strap compressing the posterior thighs.
  • Loosening the strap led to the immediate return of SSEP amplitudes and latencies to baseline.

Conclusions:

  • Improper patient positioning and the overtightening of external restraints can significantly impact IONM data, specifically SSEPs.
  • IONM clinicians must be vigilant in assessing patient positioning and identifying potential external causes of SSEP abnormalities.
  • This case underscores the importance of meticulous patient assessment and management of external factors during spinal surgery to ensure accurate neuromonitoring.