Sunderland boss David Moyes has revealed that Patrick van Aanholt had a medical issue which is why he was withdrawn prior to Spurs.
The Scot responded to suggestions that full-back van Aanholt was left annoyed, after being told in the warm-up he had been replaced in the starting line-up by Jason Denayer.
"For medical reasons we chose to withdraw him, I won't follow up if you don't mind," Moyes said.
"I'd like to be straight. We advised the referee very late on. I got word of something very late. People can get injured in the warm-up."
Sunderland sit 19th in the table and are still without a win in the league under Moyes.
On his side's poor start to the campaign, Moyes added: "We need momentum, to pick up and find a way of getting some wins. We need to feel better about ourselves."