Operative Planning

• Magnetic resonance imaging (MRI) scan
  
• Computed tomography (CT) myelogram if MRI not possible, equivocal or for reoperation
  
• Preoperative planning: selection of implant type and possibly size
  
  
  
  
  • Height of disc space
    
  • Bone quality
  
  
• Flexion/extension films
  
• Preoperative CT scan for navigation
  
• Decision on open versus minimal access technique; depends on surgeon experience, preference, and patient anatomy
  
• Decision on fusion strategy: autograft or allograft bone, fusion enhancing substances, bone morphogenic protein (BMP), bone marrow

• Jackson table (radiolucent table)
  
• C-arm fluoroscopy
  
  
  
  
  • Isocentric (Iso-C) for three-dimensional (3D) imaging; can be used as regular fluoroscopy, to check screw placement intraoperatively, or for stereotactic navigation
  
  
• Instrumentation for open or minimal access surgery, implants, fusion material: autograft or allograft bone, BMP, etc.
  
• Microscope (surgeon preference) and/or loupes and headlight
  
• High-speed drill
  
• Cobb retractors
  
• Tools for discectomy, preparation of endplates, and insertion of interbody implant (surgeon preference)
  
• Intraoperative monitoring of electromyography/somatosensory evoked potentials
  
• Operating room set-up
  
• Jackson table with chest and hip support
  
• Regular fluoroscopy or Iso-C, screen across from surgeon
  
• Microscope (surgeon preference)
  
• Stereotactic navigation system (surgeon preference)
  
• Cell saver (multilevel surgery)

Anesthetic Issues

• Intravenous antibiotics 30 minute preoperative
  
• Monitoring: arterial line, large bore venous access
  
• Foley catheter