Imaging

• Plain x-rays to evaluate alignment, count ribs, and identify natural fiducials, which may facilitate correlation of intraoperative imaging findings with magnetic resonance images
  
• Computed tomography is useful for the above purposes as well as to evaluate bone quality and to size implants.

Preoperative Care

• Somatosensory and motor evoked potentials as indicated
  
• Pulmonary function tests if single lung ventilation may be required (typically above T8)

Equipment

• Self retaining and table-mounted thoracic/retroperitoneal retraction systems
  
• Extended length Bovie may be useful
  
• Long handled Kerrisons, pituitaries, and curettes
  
• Long Frazier suction tips may be useful

Operating Room Set-up

• Double lumen endotracheal tube or bronchial obturator may facilitate single lung ventilation for upper thoracic approaches.
  
• Somatosensory and motor-evoked potential monitoring (optional)
  
• Right lateral decubitus position allows for left-sided thoracotomy/thoraco-abdominal approaches, which are preferred because of relative ease of mobilizing the aorta versus the vena cava.

• Right (typically) lateral decubitus position on operating table (bottom leg bent, top leg straight, pillow between the knees). For lumbar exposure, consider complete right (dependent) lower extremity flexion and moderate left (superior) lower extremity flexion (versus straight) to facilitate psoas retraction.
  
• Consider use of beanbag to secure patient in lateral position with care to pad pressure points, especially the dependent areola.
  
• Drape iliac crest into field in case autograft is needed.
  
• Safety straps at shoulder, thigh, and calf levels to allow for safe table rotation as needed during the exposure, decompression, and reconstruction
  
• Axillary roll