Intraoperative Lower Extremity SSEP Absence from Over-Tightened Safety Strap: Case Report

Somatosensory evoked potentials (SSEPs) are used in spinal surgeries to monitor the functional integrity of dorsal column medial lemniscal pathways. Changes to waveform amplitudes can be due to surgical manipulation, in addition to many outside factors. We describe a posterior lumbar decompression/fusion case in which lower extremity (LE) SSEPs were performed and deteriorated bilaterally. These changes were found to be related to a safety strap traversing the posterior thighs that was excessively tight, causing neurological dysfunction. After loosening the strap, SSEP amplitudes and latencies returned to baseline parameters. This observation demonstrates the importance of careful patient positioning and application of external restraints. Numerous reports have described upper extremity (UE) positioning issues, but there are few that detail LE positioning issues. Intraoperative neuromonitoring (IONM) clinicians should be aware of various potential effects of improper positioning on IONM data and be vigilant in recognizing these instances.