Spinal Cord integerity risk & Tibial single Trial SSEP?

Single trial Tibial Somatosensory SSEP along with H-reflex can be used to monitor the spinal cord integerity and function during surgical procedures that put the cord in risk. The following article
describes how this combination of a single trial SSEP can be
useful?.

When spinal cord functional integrity is at risk during surgery, intraoperative neuromonitoring is recommended.

Tibial Single Trial Somatosensory Evoked Potentials (SEPs) and H-reflex are here used in a combined neuromonitoring method: both signals monitor the spinal cord status, though involving different nervous pathways.

However, SEPs express a trial-to-trial variability that is difficult to track because of the intrinsic low signal-to-noise ratio. For this reason single trial techniques are needed to extract SEPs from the background EEG.