The patient is positioned prone on a radiolucent table with two horizontally placed padded bolsters (one at the level of the sternum and another at the level of the anterior iliac spine) or on a Jackson table frame.
General anesthesia with endotracheal intubation is required.
Antibiotics should be administered prior to incision and at two-hour intervals during the procedure.
A cephalosporin antibiotic with good Gram-positive coverage is generally recommended.
Patients with penicillin allergies should receive vancomycin or clindamycin.
Spinal cord monitoring is optional and typically includes free running and triggered EMGs. In cases where patients also have cervical or thoracic stenosis, SSEP and MEP monitoring should be considered.
The incision can be planned based on AP and lateral fluoroscopy.
If a microscope is used, it should be placed on the surgeon’s side and opposite the image intensifier portion of the C-arm fluoroscope.