Supine position for mini open retroperitoneal approach (L4-S1)

The patient is placed onto a radiolucent table in a supine position.

A pillow is placed underneath the knees. Slight knee/hip flexion allows the psoas muscle to relax, which eases the approach.

General anesthesia with endotracheal intubation is required.

Pulse-Oximetry should be placed on the left great toe.

The use of a blood salvage techniques (eg, cell saver) is recommended.

Antibiotics should be administered well prior to the incision and also at intervals during the procedure or when the blood loss exceeds 2 liters.

A cephalosporin antibiotic with good gram positive coverage is generally recommended. Local bacterial spectrum will need to be taken into account; this should be discussed with the hospital microbiologist.

Spinal cord monitoring is optional.

Fluoroscopy is mandatory. Preoperatively, it has to be assured that the C-arm can be moved around the patient freely.