Operative Planning

• Imaging
  
  
  
  • Magnetic resonance imaging (MRI)
    
  • Computed tomography myelogram if MRI is inconclusive
    
  • Flexion/extension x-rays
  
  
• Patient counseling regarding surgical risks
  
  
  
  • Postoperative pain
    
  • Potential joint instability

Equipment

• Basic spine tray
  
• High-speed drill (Midas Rex with AM-8 bit)
  
• One- and 2-mm Kerrison punches

Operating Room Set-up

• Headlight
  
• Loupes
  
• Microscope
  
• Bipolar cautery and Bovie cautery
  
• Intraoperative x-ray
  
• Intraoperative fluoroscopy
  
• Mayfield head holder

Anesthetic Issues

• Consider awake fiberoptic intubation to avoid passive neck extension
  
• Assess patient’s pulmonary function for ability to tolerate prone position
  
• Prophylactic intravenous antibiotics (cefazolin 2 g for adults) 30 minutes prior to incision
  
• Foley catheter for prolonged surgery