Imaging

• P lain x-rays
  
  
  
  • Determine number of ribs for localization
    
  • Assess deformity and/or instability
  
  
• Magnetic resonance imaging (MRI)
  
  
  
  • Determine extent of neural element compression
  
  
• Computed tomography
  
  
  
  • Evaluate bony anatomy
  
  
• Computed tomography/myelogram
  
  
  
  • If MRI contraindicated

Operative Planning

• Patient counseling regarding risk, benefits, and postoperative course

Routine Equipment

• Basic spine tray including Kerrison rongeurs (2 to 4 mm)
  
• Cautery—monopolar and bipolar
  
• High-speed drill (e.g., Midas Rex)
  
• Headlight and loupe magnification

Special Equipment

• Cell Saver (Haemonetics, Braintree, MA)—if significant blood loss is anticipated in the absence of infection/neoplastic disease
  
• Microscope for intradural pathology

Operating Room Set-up

Anesthetic Issues

• Secure endotracheal tube for prone position
  
• Appropriate blood pressure monitoring
  
• Foley catheter for extended cases (beyond 3 hours)
  
• Perioperative antibiotics 30 minutes prior to skin incision
  
• Perioperative steroids for decompressive or intradural pathology
  
• Avoid any orbital compression if patient’s face is placed on cushioned mask