Planning and positioning
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Regular operating room table is positioned in reverse orientation to allow for C-arm.
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The patient is placed in lateral decubitus position for thoracotomy, usually left side up (to avoid aortic arch).
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An axillary roll is placed underneath the upper chest region to protect brachial plexus.
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The lower arm is supported on a regular arm board, and the upper arm is supported by an arm rest.
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It is important to verify the level of disk herniation on magnetic resonance imaging (MRI) or computed tomography (CT) preoperatively and to decide on the localization strategy (e.g., count from T1 down or up from T12 [verify patient has 12 ribs]; count from sacrum [evaluate for transitional vertebrae]). It is also possible to place a small metallic marker under CT guidance preoperatively to localize the level.
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A double-lumen tube should be used for intubation.
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Neuromonitoring with motor evoked potentials and somatosensory evoked potentials should be performed.
Figure 64-1:
The patient is placed in the lateral decubitus position and secured with tape.
Procedure
