Somatosensory-evoked potential monitoring detects iliac artery occlusion during posterior spinal fusion

Change in somatosensory evoked potentials detect an acute arterial stent occlusion in lower extremity during spinal surgery: Case report

The authors report a case in which an acute thrombosis of a pre-existing arterial stent occurs in a patient's lower extremity during a lumbar spinal fusion surgery. The event was detected by acute changes in somatosensory evoked potentials (SSEPs) which were being monitored during the procedure. The neurophysiology technologist reported a 10 % increased latency and 50 % loss of amplitude in the left posterior tibial nerve recordings. While still in the operating room, further investigation, including doppler and arteriogram, demonstrated a complete occlusion of one of the two contiguous stents within the superficial femoral artery (SFA). A vascular surgeon was then able to emergently perform trans-arterial thrombectomy and restore flow through the extremity while still in the operating room. The observed events demonstrate the ability of SSEP monitoring to potentially detect arterial occlusion early, allowing for a rapid diagnosis and expedient treatment, in this case immediate, thus avoiding significant limb threatening morbidity.