Imaging

• Magnetic resonance imaging to assess spinal cord compression
  
• Plain x-rays to evaluate alignment
  
• Dynamic, flexion/extension radiographs can be helpful in the evaluation of flexibility of the spine and ability to restore alignment without osteotomies
  
• Computed tomography with sagittal reconstructions to evaluate alignment and to visualize limitations of possible exposure (level of sternal notch, angu-lation of disc spaces, and depth of spine from skin surface)

Preoperative Care

• Somatosensory evoked potentials/motor evoked potentials may be useful

Equipment

• Self retaining anterior cervical retraction system (if possible, obtain two sets or longer blades)

Operating Room Set-up

• Somatosensory and motor evoked potential monitoring (optional)
  
• Fluoroscopy (consider draping into field)
  
• Balanced microscope

Positioning

• Supine on operating table
  
• Head fixed in Mayfield head holder if destabilizing osteotomies/anterior releases are planned