Key result
Simultaneous bilateral PTN stimulation during SSEP monitoring can yield false-negative responses for unilateral nerve injury.
Case Report (n=1)
Simultaneous bilateral stimulation during SSEP monitoring can yield false negative results, highlighting the need for independent stimulation of each leg.
Bilateral tibial SSEP risks missing unilateral injury during spinal surgery; case report leaves open whether unilateral protocols improve detection.
A 43 year old man underwent spinal cord surgery for removal of filum terminale lipoma. Intraoperative somatosensory evoked potentials (SSEP) monitoring showed a transient loss of response on simultaneous bilateral posterior tibial nerve (PTN) stimulation that recovered within 20 minutes. The patients exhibited paralysis and abnormal proprioceptive perception in the right leg postoperatively, when SSEP recordings revealed abnormal response to right PTN and normal response to bilateral PTN stimulation. In order to avoid false negative intraoperative responses, stimulation of each leg independently in an alternative fashion is recommended.
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Mahsa Molaie (1986) conducted a case report in Filum terminale lipoma (n=1). Simultaneous bilateral posterior tibial nerve (PTN) stimulation was evaluated on False negative intraoperative SSEP response. Simultaneous bilateral posterior tibial nerve stimulation during intraoperative SSEP monitoring can yield false-negative responses, failing to detect unilateral nerve injury.
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