Lower Extremity Somatosensory Evoked Potential P37 Waveform Optimization

ABSTRACT

Somatosensory evoked potentials (SEPs) using tibial nerve stimulation are used during neurophysiologic intraoperative monitoring (NIOM). These SEPs produce a P37 waveform that is recorded from scalp electrodes. In this study, we attempted to determine the best derivation for recording the P37 waveform. Surgical cases using tibial nerve SEP NIOM were reviewed. Only cases in which the P37 was recorded using all of the following derivations were analyzed: centroparietal ipsilateral–centroparietal contralateral (CPi-CPc), centroparietal midline–frontopolar midline (CPz-Fpz), and CPz-CPc. The amplitude of the P37 waveform was measured in each derivation. Descriptive statistics were obtained for the P37 waveform amplitude. The mean amplitude in each of the derivations was compared using a chi-square test. Data from 39 patients (78 lower limbs) were available for analysis. The mean age of the patients was 49.64 years (range: 4–87 years); 18 were female. The highest amplitude P37 waveform was recorded from the CPz-Fpz derivation in 29 (35.4%) limbs, whereas the CPz-CPc and CPi-CPc derivations showed the highest amplitude in 29 (35.4%) and 20 (24.4%) limbs, respectively. The mean amplitudes were not significantly different between the various derivations. In only 10 (24.4%) of patients was the best derivation the same for both left and right limbs. A single best derivation was not found for recording the P37 waveform. Multiple derivations should be used to record cortical channels whenever possible. If the number of available channels is limited, using at least the CPz-Fpz and CPz-CPc derivations is recommended.

KEY WORDS:

• Optimization
• P37 waveform
• somatosensory evoked potentials
• tibial

ACKNOWLEDGMENTS

The authors would like to thank all the NIOM technologists at Duke University Medical Center for their help in acquiring the data for this study.