Imaging

• Magnetic resonance imaging (level of nerve root involvement)
  
• Computed tomography
  
• Bone scan
  
• Metastatic work-up

Biopsy

• For diagnosis
  
• Plan extent of resection
  
• Plan biopsy tract to be included and excised in definitive surgery
  
• Patient counseling
  
• Postoperative deficits: bowel/bladder incontinence, sexual dysfunction, neurologic deficits

Bowel Preparation

• Neomycin/erythromycin and polyethylene glycol electrolyte solution by mouth

Equipment

• Basic spine tray
  
• High-speed drill
  
• Osteotomes
  
• Cell saver
  
• Andrews table

Operating Room Set-up

Anesthetic Issues

• Prepare for large blood loss (3 to 10 liters)
  
• Large bore intravenous access
  
• Central line or Swan-Ganz monitoring if necessary
  
• Foley cather
  
• Consider steroids if neural manipulation is likely